1750443719 NPI number — WELLSPAN MEDICAL GROUP

Table of content: (NPI 1750443719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750443719 NPI number — WELLSPAN MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLSPAN MEDICAL GROUP
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:
1750443719
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1803 MOUNT ROSE AVE
Provider Second Line Business Mailing Address:
SUITE B3
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17403-3051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-851-1405
Provider Business Mailing Address Fax Number:
717-812-3049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2339 S GEORGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17403-5009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-812-3040
Provider Business Practice Location Address Fax Number:
717-812-3049
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILKINSON
Authorized Official First Name:
AMY
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
717-851-1405

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007721360104 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1519307 . This is a "GATEWAY-WINDSOR RD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0068573004 . This is a "AMERIH65PA-GEORGE ST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20011318 . This is a "AMERIH MERCY-RED LION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5643320 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 82187 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1519308 . This is a "GATEWAY-GEORGE STREET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0068573002 . This is a "AMERIH65PA-RED LION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 147455 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CA3246 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: KX53 . This is a "CAREFIRST MD BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1142418 . This is a "AMERIH MERCY-GEORGE ST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 800174 . This is a "JOHN HOPKINS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007721360097 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: S1E0 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 03058500 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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