1134460074 NPI number — THE MILTON S. HERSHEY MEDICAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134460074 NPI number — THE MILTON S. HERSHEY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE MILTON S. HERSHEY MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OUTPATIENT PSYCH CLINIC - BERNVILLE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134460074
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 UNIVERSITY DR
Provider Second Line Business Mailing Address:
MC A410
Provider Business Mailing Address City Name:
HERSHEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17033-2360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-243-1455
Provider Business Mailing Address Fax Number:
717-531-7269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2494 BERNVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19605-9469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-898-1800
Provider Business Practice Location Address Fax Number:
610-898-1258
Provider Enumeration Date:
03/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HALEY
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
717-531-8521

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X , with the licence number:  327730 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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