Healthcare Provider Details

I. General information

NPI: 1558287292
Provider Name (Legal Business Name): SAMUEL CHARLES HURST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 N READING RD
EPHRATA PA
17522-9802
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-738-5275
  • Fax: 717-738-5278
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-851-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA067975
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: