Provider Demographics
NPI:1760568885
Name:WELLSPAN MEDICAL GROUP
Entity Type:Organization
Organization Name:WELLSPAN MEDICAL GROUP
Other - Org Name:GETTYSBURG HOSPITALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
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:717-339-2011
Practice Address - Street 1:147 GETTYS ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2534
Practice Address - Country:US
Practice Address - Phone:717-339-2025
Practice Address - Fax:717-339-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20048461OtherAMERIHEALTH MERCY
PA2631128001OtherAMERIHEALTH 65PA
PA7726910OtherAETNA
PA1007721360249Medicaid
PA1551482OtherGATEWAY
PACA3246OtherRAILROAD MEDICARE
PA175372OtherUNISON
MD401065509OtherMD MEDICAL ASSISTANCE
PA1789770OtherHIGHMARK BLUE SHIELD
PA50055993OtherCAPITAL BLUE CROSS
PAKX54OtherCAREFIRST MD BC/BS
PA271JOtherGEISINGER
PA1551482OtherGATEWAY
PA117038FLTMedicare PIN