Healthcare Provider Details

I. General information

NPI: 1073613345
Provider Name (Legal Business Name): EVANGELICAL MEDICAL SERVICES ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
LEWISBURG PA
17837-9314
US

IV. Provider business mailing address

1 HOSPITAL DR
LEWISBURG PA
17837-9314
US

V. Phone/Fax

Practice location:
  • Phone: 570-522-4110
  • Fax: 570-522-4120
Mailing address:
  • Phone: 570-522-4110
  • Fax: 570-522-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: KENDRA A AUCKER
Title or Position: SENIOR VICE PRESIDENT/PRESIDENT
Credential:
Phone: 570-522-2807