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1635 West Main Street Suite 700 Ephrata PA 17522-1119 | |
(717) 738-0660 | |
(717) 738-0658 |
Full Name | |
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Speciality | Family Medicine |
Location | 1635 West Main Street, Ephrata, Pennsylvania |
Authorized Official Name and Position | Denise Kennedy (VICE PRESIDENT FINANCIAL SERVICES) |
Authorized Official Contact | 7175445010 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1635 West Main Street Suite 700 Ephrata PA 17522-1119 Ph: (717) 738-0660 | 1635 West Main Street Suite 700 Ephrata PA 17522-1119 Ph: (717) 738-0660 |
NPI Number | 1134164676 |
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Provider Enumeration Date | 06/18/2006 |
Last Update Date | 11/16/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134164676 | NPI | - | NPPES |
1555387 | Other | PA | GATEWAY HEALTH PLAN |
336301 | Other | PA | AETNA CAP OFFICE# |
S1QF | Other | PA | GEISINGER HEALTH PLAN |
1007327490105 | Medicaid | PA | |
1282458 | Other | PA | AETNA HMO |
1016598680105 | Medicaid | PA | |
1875158 | Other | PA | HIGHMARK BLUE SHIELD |
50060200 | Other | PA | CAPITAL BLUE CROSS |
7991794 | Other | PA | AETNA NON-HMO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |