Basic Information
| Provider Information | |||||||||
| NPI: | 1528151701 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GSH HOME MED CARE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WELLSPAN MEDICAL EQUIPMENT | ||||||||
| 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: | 7173352332 | ||||||||
| Practice Location | |||||||||
| Address1: | 1081 SHARP AVE | ||||||||
| Address2: | |||||||||
| City: | EPHRATA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175221135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177214299 | ||||||||
| FaxNumber: | 7177334302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 08/06/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ZIMMERMAN | ||||||||
| AuthorizedOfficialFirstName: | ROY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SR DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7176392664 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GSH HOME MED CARE | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | PA | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 1519615 | 01 | PA | GATEWAY HEALTH PLAN | OTHER | 0039289000 | 01 | PA | PERSONAL CHOICE PPO | OTHER | 1000856 | 01 | PA | AMERIHEALTH MERCI | OTHER | 1007464680120 | 05 | PA | MEDICAID | 39HA37 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 217220 | 01 | PA | HEALTH AMERICA/ASSURANCE | OTHER | 0533068 | 01 | PA | AETNA | OTHER | 000000124064 | 01 | PA | UNISON HEALTH PLAN | OTHER | 207557 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |