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General NPI Number Information
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NPI Number | 1528714995
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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 | 02/24/2022
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 1211 FORGE RD STE 500
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City | CARLISLE
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State | PA
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Zip | 17013-3186
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Country | US
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Telephone | 717-218-3990
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Fax | 717-218-3991
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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 | 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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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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