Healthcare Provider Details

I. General information

NPI: 1245376821
Provider Name (Legal Business Name): THE MILTON S. HERSHEY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 W GOVERNOR RD BRIARCREST SQUARE, SUITE 250
HERSHEY PA
17033-2307
US

IV. Provider business mailing address

PO BOX 856 MC A410
HERSHEY PA
17033-0856
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-7235
  • Fax: 717-531-0067
Mailing address:
  • Phone: 717-531-1159
  • Fax: 717-531-7269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number327730
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1007653100030
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DONALD MCKENNA
Title or Position: PRESIDENT
Credential:
Phone: 717-531-3979