Healthcare Provider Details

I. General information

NPI: 1154322121
Provider Name (Legal Business Name): MID PENN ANESTHESIA P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
LEWISBURG PA
17837-9314
US

IV. Provider business mailing address

PO BOX 947
CHAMBERSBURG PA
17201-0947
US

V. Phone/Fax

Practice location:
  • Phone: 570-522-2629
  • Fax:
Mailing address:
  • Phone: 717-263-5562
  • Fax: 717-263-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: GEORGE TENEDIOS
Title or Position: PRESIDENT
Credential: MD
Phone: 717-263-5562