Provider Demographics
NPI:1841352226
Name:MOUNT WOLF MEDICAL CENTER PC
Entity type:Organization
Organization Name:MOUNT WOLF MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BUTTREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-266-3631
Mailing Address - Street 1:44 NORTH FIFTH STREET
Mailing Address - Street 2:PO BOX 846
Mailing Address - City:MOUNT WOLF
Mailing Address - State:PA
Mailing Address - Zip Code:17347
Mailing Address - Country:US
Mailing Address - Phone:717-266-3631
Mailing Address - Fax:717-266-6751
Practice Address - Street 1:44 NORTH FIFTH STREET
Practice Address - Street 2:
Practice Address - City:MOUNT WOLF
Practice Address - State:PA
Practice Address - Zip Code:17347
Practice Address - Country:US
Practice Address - Phone:717-266-3631
Practice Address - Fax:717-266-6751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty