Provider Demographics
NPI:1780604181
Name:SIMS, MICHAEL EUGENE (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EUGENE
Last Name:SIMS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 TEABERRY DR
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-9042
Mailing Address - Country:US
Mailing Address - Phone:717-265-3245
Mailing Address - Fax:
Practice Address - Street 1:4400 CARLISLE PIKE
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4132
Practice Address - Country:US
Practice Address - Phone:717-975-9800
Practice Address - Fax:717-975-5509
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000165363AM0700X
PAMA001841L363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant