Provider Demographics
NPI:1336470483
Name:LANCASTER GENERAL MEDICAL GROUP
Entity Type:Organization
Organization Name:LANCASTER GENERAL MEDICAL GROUP
Other - Org Name:LANCASTER GENERAL HEALTH EXPRESS - LINCOLN HIGHWAY
Other - Org Type:Other Name
Authorized Official - Title/Position:SR. VP, PHYSICIAN SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-544-4001
Mailing Address - Street 1:2034 LINCOLN HWY E
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-3329
Mailing Address - Country:US
Mailing Address - Phone:717-735-2302
Mailing Address - Fax:717-735-2307
Practice Address - Street 1:2034 LINCOLN HWY E
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-3329
Practice Address - Country:US
Practice Address - Phone:717-735-2302
Practice Address - Fax:717-735-2307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA616918Medicare PIN