Basic Information
| Provider Information | |||||||||
| NPI: | 1164857207 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEHIGH GORGE INPATIENT SERVICES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 WITMER RD | ||||||||
| Address2: | STE 220 | ||||||||
| City: | HORSHAM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190442291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154425000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 211 N 12TH ST | ||||||||
| Address2: | |||||||||
| City: | LEHIGHTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 182351138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154425000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2013 | ||||||||
| LastUpdateDate: | 10/03/2013 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | RUSSELL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2154425029 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.