MEDICARE: LANCASTER GASTROENTEROLOGY PROCEDURE CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0800X	Endoscopy Clinic/Center	17211501	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00068382	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720061831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANCASTER GASTROENTEROLOGY PROCEDURE CENTER LLC

Provider Business Mailing Address
First Line	:	2112 HARRISBURG PIKE
Second Line	:	SUITE 323
City	:	LANCASTER
State	:	PA
Zip	:	17601-2644
Country	:	US
Telephone Number	:	717-544-3569
Fax Number	:	717-544-3570

Provider Business Practice Location Address
First Line	:	2112 HARRISBURG PIKE
Second Line	:	SUITE 323
City	:	LANCASTER
State	:	PA
Zip	:	17601-2644
Country	:	US
Telephone Number	:	717-544-3569
Fax Number	:	717-544-3570

Authorized Official
Title or Position	:	CHIEF MANAGER OF LLC
Name	:	MR. CHRISTOPHER A HOLDEN
Credential	:
Telephone Number	:	615-665-1283

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	11/14/2008

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