Basic Information
| Provider Information | |||||||||
| NPI: | 1841637733 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EPHRATA COMMUNITY HOSPITAL | ||||||||
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| OtherOrganizationName: | WELLSPAN EPHRATA COMMUNITY HOSPITAL WOUND HEALING & HYPERBARIC SERVICE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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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: | 175 MARTIN AVE | ||||||||
| Address2: | SUITE 355 | ||||||||
| City: | EPHRATA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175221761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177386674 | ||||||||
| FaxNumber: | 7177215938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2013 | ||||||||
| LastUpdateDate: | 11/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | CITRO | ||||||||
| AuthorizedOfficialFirstName: | TINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP & PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7177386407 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0011X | 310301 | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1007464680006 | 05 | PA | MEDICAID |