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General NPI Number Information
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NPI Number | 1750373965
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Entity Type | Organization
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Legal Business Name | PENN STATE HEALTH COMMUNITY MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 01/07/2019
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Provider Practice Location Address
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Address Line | 3912 TRINDLE RD
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City | CAMP HILL
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State | PA
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Zip | 17011-4246
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Country | US
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Telephone | 717-761-8740
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Fax | 717-761-8792
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Provider Business Mailing Address
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Address Line | 3912 TRINDLE RD
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City | CAMP HILL
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State | PA
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Zip | 17011-4246
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Country | US
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Telephone | 717-761-8740
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Fax | 717-761-8792
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Authorized Official
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Title or Position | EX. VICE PRES, CHIEF FINANCIAL OFC.
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Name | STEPHEN MASSINI
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Credential |
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Telephone | 717-531-6614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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