Basic Information
| Provider Information | |||||||||
| NPI: | 1760769442 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EVANGELICAL MEDICAL SERVICES ORGANIZATION | ||||||||
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| OtherOrganizationName: | EMSO FAMILY MEDICAL CARE LAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 132 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | LEWISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178379315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705224110 | ||||||||
| FaxNumber: | 5705222194 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 FORESTWOOD DR | ||||||||
| Address2: | |||||||||
| City: | LEWISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178376213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705245050 | ||||||||
| FaxNumber: | 5705245250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2011 | ||||||||
| LastUpdateDate: | 11/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | GIBBONS | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ASSOCIATE VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5705224158 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | MD058238L | PA | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.