Basic Information
| Provider Information | |||||||||
| NPI: | 1083615587 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EPHRATA COMMUNITY HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WELLSPAN EPHRATA COMMUNITY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE STE 3 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7177096529 | ||||||||
| Practice Location | |||||||||
| Address1: | 169 MARTIN AVE | ||||||||
| Address2: | |||||||||
| City: | EPHRATA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175221002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177382517 | ||||||||
| FaxNumber: | 7177339442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | CITRO | ||||||||
| AuthorizedOfficialFirstName: | TINA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP & PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7177386407 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 310301 | PA | N | Ambulatory Health Care Facilities | Clinic/Center | 261QE0002X | 310301 | PA | N | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care | 261QH0700X | 310301 | PA | N | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech | 261QM1200X | 310301 | PA | N | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) | 261QR0200X | 310301 | PA | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 261QR0206X | 310301 | PA | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mammography | 261QR0400X | 310301 | PA | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | 261QU0200X | 310301 | PA | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 261QX0200X | 310301 | PA | N | Ambulatory Health Care Facilities | Clinic/Center | Oncology | 282N00000X | 310301 | PA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 100746468 | 05 | PA | MEDICAID |