Provider Demographics
NPI:1972643450
Name:LEWISTOWN AMBULATORY CARE CORPORATION
Entity Type:Organization
Organization Name:LEWISTOWN AMBULATORY CARE CORPORATION
Other - Org Name:RABIA AL-SBAITI, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FHA OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHURGALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-242-7103
Mailing Address - Street 1:215 N BEECH ST
Mailing Address - Street 2:
Mailing Address - City:BURNHAM
Mailing Address - State:PA
Mailing Address - Zip Code:17009-1600
Mailing Address - Country:US
Mailing Address - Phone:717-248-5200
Mailing Address - Fax:717-248-2725
Practice Address - Street 1:215 N BEECH ST
Practice Address - Street 2:
Practice Address - City:BURNHAM
Practice Address - State:PA
Practice Address - Zip Code:17009-1600
Practice Address - Country:US
Practice Address - Phone:717-248-5200
Practice Address - Fax:717-248-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty