1215110531 NPI number — EVANGELICAL MEDICAL SERVICES ORGANIZATION

Table of content: (NPI 1215110531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215110531 NPI number — EVANGELICAL MEDICAL SERVICES ORGANIZATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVANGELICAL MEDICAL SERVICES ORGANIZATION
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:
Provider Other Organization Name Type Code:
6
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:
1215110531
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17837-9315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-522-4134
Provider Business Mailing Address Fax Number:
570-522-4120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
412 W MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLEBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17842-1076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-837-6163
Provider Business Practice Location Address Fax Number:
570-837-7224
Provider Enumeration Date:
12/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AUCKER
Authorized Official First Name:
KENDRA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
570-522-2807

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , 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)

  • Identifier: 1007498260025 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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