Provider Demographics
NPI:1083615587
Name:EPHRATA COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:EPHRATA COMMUNITY HOSPITAL
Other - Org Name:WELLSPAN EPHRATA COMMUNITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CITRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-738-6407
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:169 MARTIN AVE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1724
Practice Address - Country:US
Practice Address - Phone:717-733-0311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA310301261Q00000X, 261QE0002X, 261QH0700X, 261QM1200X, 261QR0200X, 261QR0206X, 261QR0400X, 261QU0200X, 261QX0200X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100746468Medicaid
PA1007464680006Medicaid
PA60741Medicaid