Healthcare Provider Details

I. General information

NPI: 1942227632
Provider Name (Legal Business Name): EVANGELICAL MEDICAL SERVICES ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7095 WESTBRANCH HWY SUITE 1000
LEWISBURG PA
17837-6864
US

IV. Provider business mailing address

1 HOSPITAL DR SUITE 306
LEWISBURG PA
17837-9350
US

V. Phone/Fax

Practice location:
  • Phone: 570-523-3006
  • Fax: 570-523-0404
Mailing address:
  • Phone: 570-522-4110
  • Fax: 570-768-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: KENDRA A AUCKER
Title or Position: SENIOR VICE PRESIDENT/PRESIDENT
Credential:
Phone: 570-522-2501