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General NPI Number Information
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NPI Number | 1467859363
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Entity Type | Organization
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Legal Business Name | PHMG ANNVILLE LLC
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 475 N WEABER ST
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City | ANNVILLE
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State | PA
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Zip | 17003-1104
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Country | US
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Telephone | 717-867-4671
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Fax | 717-867-4981
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Provider Business Mailing Address
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Address Line | 307 S FRONT ST 1ST FLOOR
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City | HARRISBURG
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State | PA
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Zip | 17104-1621
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SENIOR VP
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Name | MR. CHRISTOPHER P MARKLEY
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Credential |
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Telephone | 717-231-8210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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