Provider Demographics
NPI:1760550610
Name:WELLSPAN MEDICAL GROUP
Entity Type:Organization
Organization Name:WELLSPAN MEDICAL GROUP
Other - Org Name:BIGLERVILLE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-851-1405
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3051
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-677-7810
Practice Address - Street 1:2060 CARLISLE ROAD
Practice Address - Street 2:
Practice Address - City:ASPERS
Practice Address - State:PA
Practice Address - Zip Code:17304-9707
Practice Address - Country:US
Practice Address - Phone:717-339-2590
Practice Address - Fax:717-677-7810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA122151OtherUNISON
PA1382352OtherHIGHMARK BLUE SHIELD
PAS1ELOtherGEISINGER
PA03255900OtherCAPITAL BLUE CROSS
MD401065504OtherMD MEDICAL ASSISTANCE
MDKX10OtherCAREFIRST MD BCBS
PA1520912OtherGATEWAY
PACA3246OtherRAILROAD MEDICARE
PA7974869OtherAETNA
PA800174OtherJOHN HOPKINS
PA1007721360122Medicaid
PA20013068OtherAMERIHEALTH MERCY
PA20013068OtherAMERIHEALTH MERCY
PA800174OtherJOHN HOPKINS