Provider Demographics
NPI:1508068230
Name:CEDAR LAKE MEDICAL CENTER, PA
Entity Type:Organization
Organization Name:CEDAR LAKE MEDICAL CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEYFARTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:2283-850-0075
Mailing Address - Street 1:1759 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2132
Mailing Address - Country:US
Mailing Address - Phone:228-385-0075
Mailing Address - Fax:228-385-0073
Practice Address - Street 1:1759 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2132
Practice Address - Country:US
Practice Address - Phone:228-385-0075
Practice Address - Fax:228-385-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty