Provider Demographics
NPI:1558486928
Name:LEWISTOWN HOSPITAL
Entity Type:Organization
Organization Name:LEWISTOWN HOSPITAL
Other - Org Name:DEPT OF PSYCHIATRY
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:E
Authorized Official - Last Name:TEWKSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-242-7650
Mailing Address - Street 1:400 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-1167
Mailing Address - Country:US
Mailing Address - Phone:717-248-5411
Mailing Address - Fax:717-242-7421
Practice Address - Street 1:400 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1167
Practice Address - Country:US
Practice Address - Phone:717-248-5411
Practice Address - Fax:717-242-7421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA121501103T00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA400603Medicare ID - Type UnspecifiedPSYCHIATRIC PHYSICIANS