Basic Information
| Provider Information | |||||||||
| NPI: | 1588628465 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HANOVER HEALTH CORPORATION INC | ||||||||
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| OtherOrganizationName: | INTERNAL MEDICINE ASSOCIATES OF NEW OXFORD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 HIGHLAND AVENUE | ||||||||
| Address2: | |||||||||
| City: | HANOVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176333511 | ||||||||
| FaxNumber: | 7176460188 | ||||||||
| Practice Location | |||||||||
| Address1: | 5615 YORK ROAD | ||||||||
| Address2: | |||||||||
| City: | NEW OXFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176241337 | ||||||||
| FaxNumber: | 7176241795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 11/09/2007 | ||||||||
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| AuthorizedOfficialLastName: | OLEJNIK | ||||||||
| AuthorizedOfficialFirstName: | MARILYN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7176373711 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 057958 | 01 | PA | HIGHMARK BLUESHIELD | OTHER |