| Outpatient Clinic | |
|
1347 Hausman Road Lehigh Valley PA 19063-1906 | |
| (610) 891-2000 | |
| Not Available |
| Full Name | Outpatient Clinic |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1347 Hausman Road, Lehigh Valley, Pennsylvania |
| Authorized Official Name and Position | Donna K Busch (PAYER CONTRACT SPECIALIST) |
| Authorized Official Contact | 4452063028 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Outpatient Clinic 111 Elwyn Rd Outpatient Clinic Elwyn PA 19063-4622 Ph: (610) 891-2000 | Outpatient Clinic 1347 Hausman Road Lehigh Valley PA 19063-1906 Ph: (610) 891-2000 |
| NPI Number | 1275789117 |
|---|---|
| Provider Enumeration Date | 08/12/2008 |
| Last Update Date | 02/19/2022 |
| Certification Date | 02/19/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275789117 | NPI | - | NPPES |
| 1000021240672 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |