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General NPI Number Information
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NPI Number | 1407500143
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Entity Type | Organization
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Legal Business Name | PENN STATE HEALTH MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 02/11/2022
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 890 POPLAR CHURCH RD STE 210
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City | CAMP HILL
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State | PA
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Zip | 17011-2250
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Country | US
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Telephone | 717-724-6320
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Fax | 717-312-3125
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Provider Business Mailing Address
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Address Line | PO BOX 825972
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City | PHILADELPHIA
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State | PA
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Zip | 19182-5972
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Country | US
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Telephone | 717-531-4859
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Fax | 717-312-3104
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Authorized Official
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Title or Position | VP/CHIEF FINANCIAL OFFICER
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Name | TRACY L MOYER-SWINKO
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Credential |
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Telephone | 717-531-8477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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