Basic Information
| Provider Information | |||||||||
| NPI: | 1750001467 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PENN STATE HEALTH HOLY SPIRIT MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 UNIVERSITY DRIVE | ||||||||
| Address2: | MC CA410 | ||||||||
| City: | HERSHEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1717531115 | ||||||||
| FaxNumber: | 7175310119 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 FLOWERS DR | ||||||||
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| City: | MECHANICSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170501701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176121830 | ||||||||
| FaxNumber: | 7176121810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2022 | ||||||||
| LastUpdateDate: | 10/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | MORRIS | ||||||||
| AuthorizedOfficialFirstName: | RANDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7175316238 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0855X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No ID Information.