Provider Demographics
NPI:1497192975
Name:EPHRATA CENTER FOR HEART CARE
Entity Type:Organization
Organization Name:EPHRATA CENTER FOR HEART CARE
Other - Org Name:EPHRATA COMMUNITY HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADULT NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:KIRSTIN
Authorized Official - Last Name:NYMARK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:610-937-5694
Mailing Address - Street 1:2921 SANTA MARIA DR
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-9321
Mailing Address - Country:US
Mailing Address - Phone:610-828-4381
Mailing Address - Fax:
Practice Address - Street 1:169 MARTIN AVE STE 179
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1724
Practice Address - Country:US
Practice Address - Phone:717-721-5868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012874282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural