Provider Demographics
NPI:1700972338
Name:LANCASTER GENERAL HEALTH - COLUMBIA CENTER
Entity Type:Organization
Organization Name:LANCASTER GENERAL HEALTH - COLUMBIA CENTER
Other - Org Name:LGHP/PENN MEDICINE FAMILY MEDICINE TWIN ROSE COLUMBIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-544-5010
Mailing Address - Street 1:306 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17512-2137
Mailing Address - Country:US
Mailing Address - Phone:717-684-9106
Mailing Address - Fax:717-684-1666
Practice Address - Street 1:306 N 7TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512-2137
Practice Address - Country:US
Practice Address - Phone:717-684-9106
Practice Address - Fax:717-684-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1518495OtherGATEWAY
PA5738020OtherAETNA
PA03093400OtherCAPITAL BLUE CROSS
PA100771175 0005Medicaid
PA100772904 0035Medicaid
PA20026765OtherAMERIHEALTH MERCY
PACN3829OtherRAILROAD MEDICARE
PA000000143528OtherUNISON HEALTHPLAN
PA001366462OtherHIGHMARK
PA100771175 0005Medicaid