Provider Demographics
NPI:1700023041
Name:EPHRATA COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:EPHRATA COMMUNITY HOSPITAL
Other - Org Name:EPHRATA HOSPITALIST GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-738-6845
Mailing Address - Street 1:169 MARTIN AVE
Mailing Address - Street 2:PO BOX 1002
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1002
Mailing Address - Country:US
Mailing Address - Phone:717-738-6845
Mailing Address - Fax:717-738-6675
Practice Address - Street 1:169 MARTIN AVE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1002
Practice Address - Country:US
Practice Address - Phone:717-738-6845
Practice Address - Fax:717-738-6675
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPHRATA COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-08
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007464680009Medicare Oscar/Certification
PA159114Medicare PIN