MEDICARE: GSH URGENT CARE, INC

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	261QU0200X	Urgent Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	158677	OTHER	PA	HEALTH AMERICA/ASSURANCE
2	CI1341	OTHER	PA	PALMETTO GBA
3	50003047	OTHER	PA	CAPITAL BLUE CROSS
4	376476	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1770546285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GSH URGENT CARE, INC

Provider Business Mailing Address
First Line	:	956 ISABEL DR
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17042-7482
Country	:	US
Telephone Number	:	717-270-5677
Fax Number	:	717-274-1858

Provider Business Practice Location Address
First Line	:	956 ISABEL DR
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17042-7482
Country	:	US
Telephone Number	:	717-270-5677
Fax Number	:	717-274-1858

Authorized Official
Title or Position	:	SR VICE PRESIDENT AND COO
Name	:	MR. WILLIAM HENDRICK
Credential	:
Telephone Number	:	717-270-7762

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	08/07/2007

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Directions to “GSH URGENT CARE, INC ” Practice Location

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