Healthcare Provider Details

I. General information

NPI: 1275582843
Provider Name (Legal Business Name): CONESTOGA EMERGENCY PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 12/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 COLLEGE AVE
LANCASTER PA
17603-3363
US

IV. Provider business mailing address

232 LAKESIDE DR
HORSHAM PA
19044-2319
US

V. Phone/Fax

Practice location:
  • Phone: 717-291-8211
  • Fax: 717-291-8090
Mailing address:
  • Phone: 800-247-8060
  • Fax: 215-957-2875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. RUSSELL HARRIS
Title or Position: PRESIDENT
Credential: MD
Phone: 469-401-2386