Basic Information
| Provider Information | |||||||||
| NPI: | 1831227404 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE MILTON S HERSHEY MEDICAL CENTER PHYSICIANS GROUP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UPG ERFORD ROAD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 858 | ||||||||
| Address2: | MC A410 | ||||||||
| City: | HERSHEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170330858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175311159 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 ERFORD RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CAMP HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170111802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177618900 | ||||||||
| FaxNumber: | 7177611320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 04/29/2015 | ||||||||
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| AuthorizedOfficialLastName: | MASSINI | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7175318405 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 135101 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 10076500730069 | 05 | PA | MEDICAID |