MEDICARE: YORK HEALTH BOUTIQUE FOR WOMEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)	6000005630	PA
2	332BC3200X	Customized Equipment (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	211107	OTHER	PA	HIGHMARK BLUE SHIELD
2	39HA96	OTHER	PA	CAPITAL BLUE CROSS
3	123905	OTHER	PA	UNISON/THREE RIVERS/MEDPL
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	20022585	OTHER	PA	AMERI HEALTH MERCY

General Provider Information

NPI Number	:	1548239536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YORK HEALTH BOUTIQUE FOR WOMEN

Provider Business Mailing Address
First Line	:	180 LEADERS HEIGHTS RD
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-4742
Country	:	US
Telephone Number	:	717-741-0127
Fax Number	:	717-741-0168

Provider Business Practice Location Address
First Line	:	180 LEADERS HEIGHTS RD
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-4742
Country	:	US
Telephone Number	:	717-741-0127
Fax Number	:	717-741-0168

Authorized Official
Title or Position	:	PRES. (OWNER)
Name	:	MRS. URITH ANN LAVETAN
Credential	:
Telephone Number	:	717-741-0127

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	07/28/2010

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Directions to “YORK HEALTH BOUTIQUE FOR WOMEN ” Practice Location

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