Provider Demographics
NPI:1477693737
Name:THE MILTON S. HERSHEY MEDICAL CENTER
Entity Type:Organization
Organization Name:THE MILTON S. HERSHEY MEDICAL CENTER
Other - Org Name:MSHMC PARTIAL PSYCH NORTHEAST DR
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SWINKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-531-8405
Mailing Address - Street 1:PO BOX 856
Mailing Address - Street 2:MC A410
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 1:22 NORTHEAST DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2732
Practice Address - Country:US
Practice Address - Phone:717-531-1159
Practice Address - Fax:717-531-7269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2014-10-13
Deactivation Date:2010-06-16
Deactivation Code:
Reactivation Date:2014-02-26
Provider Licenses
StateLicense IDTaxonomies
PA135101261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007653100033Medicaid