Healthcare Provider Details

I. General information

NPI: 1710201322
Provider Name (Legal Business Name): LOCK HAVEN EMERGENCY PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 CREE DR
LOCK HAVEN PA
17745-2639
US

IV. Provider business mailing address

200 CORPORATE BLVD
LAFAYETTE LA
70508-3870
US

V. Phone/Fax

Practice location:
  • Phone: 570-893-5000
  • Fax:
Mailing address:
  • Phone: 800-893-9698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal 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
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1024408140001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
IdentifierDQ6250
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRR MEDICARE
# 3
Identifier184309
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICARE PIN

VIII. Authorized Official

Name: DR. DAVID S. SCHILLINGER
Title or Position: PRESIDENT
Credential: MD
Phone: 800-893-9698