Provider Demographics
NPI:1508907262
Name:LEBANON EMERGENCY PHYSICIANS PC
Entity Type:Organization
Organization Name:LEBANON EMERGENCY PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-270-7740
Mailing Address - Street 1:4TH & WALNUT ST
Mailing Address - Street 2:PO BOX 1281
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-1728
Mailing Address - Country:US
Mailing Address - Phone:717-270-7740
Mailing Address - Fax:717-270-3877
Practice Address - Street 1:4TH & WALNUT ST
Practice Address - Street 2:GOOD SAMARITAN HOSPITAL
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-1728
Practice Address - Country:US
Practice Address - Phone:717-270-7740
Practice Address - Fax:717-270-3877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012366710008Medicaid
PA661084OtherBLUE SHIELD
PA03201400OtherBLUE CROSS
PA661084OtherBLUE SHIELD