Provider Demographics
NPI:1972032761
Name:PENN STATE HEALTH COMMUNITY MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:PENN STATE HEALTH COMMUNITY MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:TINCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-531-1313
Mailing Address - Street 1:PO BOX 848
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0848
Mailing Address - Country:US
Mailing Address - Phone:610-208-8818
Mailing Address - Fax:717-312-3104
Practice Address - Street 1:2221 NOLL DR STE 2000
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-7614
Practice Address - Country:US
Practice Address - Phone:717-715-1001
Practice Address - Fax:717-431-2321
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENN STATE HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-06
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty