Provider Demographics
NPI:1720404031
Name:U.S. PENITENTIARY LEWISBURG
Entity Type:Organization
Organization Name:U.S. PENITENTIARY LEWISBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SYSTEMS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-523-1251
Mailing Address - Street 1:2400 ROBERT F MILLER DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-6850
Mailing Address - Country:US
Mailing Address - Phone:570-523-1251
Mailing Address - Fax:
Practice Address - Street 1:2400 ROBERT F MILLER DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-6850
Practice Address - Country:US
Practice Address - Phone:570-523-1251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service