1558445130 NPI number — LEBANON VA MEDICAL CENTER

Table of content: (NPI 1558445130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558445130 NPI number — LEBANON VA MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEBANON VA 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:
Provider Other Organization Name Type Code:
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:
1558445130
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51 WOODLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERSHEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17033-2157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-533-3678
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 S LINCOLN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17042-7529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-272-6621
Provider Business Practice Location Address Fax Number:
717-228-5982
Provider Enumeration Date:
10/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DYE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
INTERNAL MEDICINE - G.I.
Authorized Official Telephone Number:
717-272-6621

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  1225E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QV0200X , with the licence number: 1225E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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