Provider Demographics
NPI:1508241845
Name:LANCASTER MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:LANCASTER MEDICAL GROUP, LLC
Other - Org Name:FAMILY HEALTH CENTER OF MOUNT JOY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-291-8078
Mailing Address - Street 1:960 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552-9320
Mailing Address - Country:US
Mailing Address - Phone:717-653-0331
Mailing Address - Fax:
Practice Address - Street 1:960 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT JOY
Practice Address - State:PA
Practice Address - Zip Code:17552-9320
Practice Address - Country:US
Practice Address - Phone:717-653-0331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty