Provider Demographics
NPI:1760769442
Name:EVANGELICAL MEDICAL SERVICES ORGANIZATION
Entity Type:Organization
Organization Name:EVANGELICAL MEDICAL SERVICES ORGANIZATION
Other - Org Name:EMSO FAMILY MEDICAL CARE LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-522-4158
Mailing Address - Street 1:132 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9315
Mailing Address - Country:US
Mailing Address - Phone:570-522-4110
Mailing Address - Fax:570-522-2194
Practice Address - Street 1:45 FORESTWOOD DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-6213
Practice Address - Country:US
Practice Address - Phone:570-524-5050
Practice Address - Fax:570-524-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058238L291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory