=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881925931
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LANCASTER GENERAL MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2010
-----------------------------------------------------
Last Update Date | 11/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2118 SPRING VALLEY RD
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17601-2427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-544-0150
-----------------------------------------------------
Fax | 717-544-0151
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2118 SPRING VALLEY RD
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17601-2427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-544-0150
-----------------------------------------------------
Fax | 717-544-0151
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT FINANCIAL SERVICES
-----------------------------------------------------
Name | DENISE KENNEDY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 717-544-5010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------