Basic Information
| Provider Information | |||||||||
| NPI: | 1619371812 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LANCASTER GENERAL HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LANCASTER GENERAL HEALTH PHYSICIANS TRAUMA & ACUTE CARE SURGERY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 950 S OCTORARA TRL | ||||||||
| Address2: | |||||||||
| City: | PARKESBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193652100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175445945 | ||||||||
| FaxNumber: | 7175445944 | ||||||||
| Practice Location | |||||||||
| Address1: | 950 S OCTORARA TRL | ||||||||
| Address2: | |||||||||
| City: | PARKESBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193652100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175445945 | ||||||||
| FaxNumber: | 7175445944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2014 | ||||||||
| LastUpdateDate: | 10/20/2014 | ||||||||
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| AuthorizedOfficialLastName: | ROEMER | ||||||||
| AuthorizedOfficialFirstName: | DENNIS | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | EVP & CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7175444926 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0102X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.