Provider Demographics
NPI: | 1942227632 |
---|---|
Name: | EVANGELICAL MEDICAL SERVICES |
Entity Type: | Organization |
Organization Name: | EVANGELICAL MEDICAL SERVICES |
Other - Org Name: | URGENT CARE OF EVANGELICAL |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT/CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KENDRA |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | AUCKER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 570-522-2501 |
Mailing Address - Street 1: | 1 HOSPITAL DR |
Mailing Address - Street 2: | SUITE 306 |
Mailing Address - City: | LEWISBURG |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 17837-9350 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 570-522-4110 |
Mailing Address - Fax: | 570-768-3911 |
Practice Address - Street 1: | 7095 WESTBRANCH HWY |
Practice Address - Street 2: | SUITE 1000 |
Practice Address - City: | LEWISBURG |
Practice Address - State: | PA |
Practice Address - Zip Code: | 17837-6864 |
Practice Address - Country: | US |
Practice Address - Phone: | 570-523-3006 |
Practice Address - Fax: | 570-523-0404 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-17 |
Last Update Date: | 2018-09-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | 207Q00000X, 261QU0200X, 207RP1001X, 207T00000X, 2084N0400X, 208M00000X, 363A00000X, 363AM0700X, 363AS0400X, 363L00000X, 207P00000X, 207ZP0101X, 207ZC0500X, 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty | |
Yes | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207ZP0101X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | Group - Multi-Specialty |
No | 207ZC0500X | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | Group - Multi-Specialty |