Provider Demographics
NPI:1396347084
Name:PENN STATE HEALTH COMMUNITY MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:PENN STATE HEALTH COMMUNITY MEDICAL GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PENN STATE HEALTH CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MASSINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-531-6614
Mailing Address - Street 1:1800 CENTER ST STE 1A110
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1741
Mailing Address - Country:US
Mailing Address - Phone:717-775-5093
Mailing Address - Fax:717-775-5094
Practice Address - Street 1:1800 CENTER ST STE 1A110
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1702
Practice Address - Country:US
Practice Address - Phone:717-775-5093
Practice Address - Fax:717-775-5094
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENN STATE HEALTH COMMUNITY MEDICAL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-09
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty