Provider Demographics
NPI:1043265119
Name:FAMILY HEALTH ASSOCIATES OF GEISINGER LEWISTOWN HOSPITAL
Entity Type:Organization
Organization Name:FAMILY HEALTH ASSOCIATES OF GEISINGER LEWISTOWN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE MANAGEMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-271-6603
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6621
Mailing Address - Fax:
Practice Address - Street 1:400 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1167
Practice Address - Country:US
Practice Address - Phone:717-242-7722
Practice Address - Fax:717-242-7712
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEISINGER FAMILY HEALTH ASSOCIATES OF LEWISTOWN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-24
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008145680070Medicaid
PA668973Medicare PIN