Provider Demographics
NPI:1760787576
Name:WELLSPAN SURGERY AND REHABILITATION HOSPITAL
Entity Type:Organization
Organization Name:WELLSPAN SURGERY AND REHABILITATION HOSPITAL
Other - Org Name:WELLSPAN SURGERY AND REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCZKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-442-3373
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:55 MONUMENT RD
Practice Address - Street 2:WELLSPAN SURGERY AND REHABILITATION HOSPITAL-ACUTE CARE
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403
Practice Address - Country:US
Practice Address - Phone:717-812-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1603501OtherGATEWAY
PA102704903Medicaid
PA259852OtherJOHNS HOPKINS HEALTHCARE
PA102704903Medicaid