Provider Demographics
NPI:1063505824
Name:LANCASTER GENERAL HEALTH - COLUMBIA CENTER
Entity Type:Organization
Organization Name:LANCASTER GENERAL HEALTH - COLUMBIA CENTER
Other - Org Name:PENN MEDICINE LGHP FAMILY MEDICINE TWIN ROSE WRIGHTSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-544-5010
Mailing Address - Street 1:6415 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17368-9697
Mailing Address - Country:US
Mailing Address - Phone:717-252-1200
Mailing Address - Fax:717-252-0259
Practice Address - Street 1:6415 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17368-9697
Practice Address - Country:US
Practice Address - Phone:717-252-1200
Practice Address - Fax:717-252-0259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20026956OtherAMERIHEALTH MERCY
PA000000143528OtherUNISON HEALTHPLAN
PA001366462OtherHIGHMARK
PA100772904 0035Medicaid
PACN3829OtherRAILROAD MEDICARE
PA000000130609OtherUNISON HEALTHPLAN
PA03093400OtherCAPITAL BLUE CROSS
PA100771175 0005Medicaid
PA1518496OtherGATEWAY / ASSURED
PA5738020OtherAETNA
PA100771175 0005Medicaid