Provider Demographics
NPI:1356300453
Name:THE MILTON S. HERSHEY MEDICAL CENTER
Entity Type:Organization
Organization Name:THE MILTON S. HERSHEY MEDICAL CENTER
Other - Org Name:MS HERSHEY MEDICAL PARTIAL PSYCH HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MASSINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-531-8405
Mailing Address - Street 1:PO BOX 856
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0856
Mailing Address - Country:US
Mailing Address - Phone:717-531-1159
Mailing Address - Fax:717-531-7269
Practice Address - Street 1:905 W GOVERNOR RD
Practice Address - Street 2:SUITE 250
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2307
Practice Address - Country:US
Practice Address - Phone:717-531-7235
Practice Address - Fax:717-531-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA931180261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007653100037Medicaid
PA390775Medicare ID - Type Unspecified