Provider Demographics
NPI:1134297104
Name:WELLSPAN MEDICAL GROUP
Entity Type:Organization
Organization Name:WELLSPAN MEDICAL GROUP
Other - Org Name:ADAMS COUNTY INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-851-1405
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3051
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-338-3287
Practice Address - Street 1:450 S WASHINGTON ST
Practice Address - Street 2:SUITE E
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2500
Practice Address - Country:US
Practice Address - Phone:717-338-3285
Practice Address - Fax:717-338-3287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA345TOtherGEISINGER SP
MDKX54OtherCAREFIRST MD BCBS
PA180987OtherUNISON SPECIALIST
PAS1E9OtherGEISINGER PCP
PA20017849OtherAMERIHEALTH MERCY
PA50018391OtherCAPITAL BLUE CROSS
PA800174OtherJOHN HOPKINS
PA2133931001OtherAMERIHEALTH65PA
MD401065505OtherMD MEDICAL ASSISTANCE
PA1007721360121Medicaid
PA145555OtherUNISON PCP
PA7148888OtherAETNA
PACA3246OtherRAILROAD MEDICARE
PA1429586OtherHIGHMARK BLUE SHIELD
PA1529864OtherGATEWAY
PA1007721360121Medicaid
PA117038FLTMedicare PIN