Basic Information
| Provider Information | |||||||||
| NPI: | 1760577555 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LANCASTER GENERAL HOSPITAL | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | JAMES STREET FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 555 N. DUKE ST. | ||||||||
| Address2: | PO BOX 3555 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175444950 | ||||||||
| FaxNumber: | 7175444149 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 N. DUKE ST. | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175444950 | ||||||||
| FaxNumber: | 7175444149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 12/04/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BYORICK | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7175445511 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LANCASTER GENERAL HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2061158001 | 01 | PA | AMERIHEALTH 65 | OTHER | 1518324 | 01 | PA | GATEWAY GROUP# | OTHER | 30025858 | 01 | PA | KEYSTONE MERCY | OTHER | 172421 | 01 | PA | HEALTH AMERICA | OTHER | 100338 | 01 | PA | MERCY GROUP # | OTHER | 100771175 0005 | 05 | PA | MEDICAID | 1369108 | 01 | PA | HIGHMARK GROUP# | OTHER | 50055923 | 01 | PA | CBC GROUP# | OTHER | 000000127890 | 01 | PA | UNISON GROUP# | OTHER | 000000134934 | 01 | PA | UNISON - HBP GRP# | OTHER |