Provider Demographics
NPI:1295834984
Name:EVANGELICAL MEDICAL SERVICES ORGANIZATION
Entity Type:Organization
Organization Name:EVANGELICAL MEDICAL SERVICES ORGANIZATION
Other - Org Name:EMSO PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:AUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-522-2807
Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9350
Mailing Address - Country:US
Mailing Address - Phone:570-522-4110
Mailing Address - Fax:570-768-3911
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9350
Practice Address - Country:US
Practice Address - Phone:570-522-4110
Practice Address - Fax:570-768-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007498260092Medicaid
PACA5965OtherRAILROAD MEDICARE
PA001881626OtherHIGHMARK BLUE SHIELD
PA118438703OtherDEPARTMENT OF LABOR
PA50062067OtherCAPITAL BLUE CROSS
PA118438703OtherDEPARTMENT OF LABOR