Basic Information
| Provider Information | |||||||||
| NPI: | 1881950483 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WELLSPAN SURGERY AND REHABILITATION HOSPITAL | ||||||||
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| OtherOrganizationName: | WELLSPAN SURGERY AND REHABILITATION 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: | 55 MONUMENT RD | ||||||||
| Address2: | WELLSPAN SURGERY AND REHABILITATION HOSPITAL-PATHOLOGY | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174035023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178126163 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2012 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | BUCZKOWSKI | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VP AND CFO | ||||||||
| AuthorizedOfficialTelephone: | 4104423373 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WELLSPAN SURGERY AND REHABILITATION HOSPITAL | ||||||||
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| NPICertificationDate: | 11/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WV0400X | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Vision Therapy | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1608970 | 01 | PA | GATEWAY | OTHER | 30124632 | 01 | PA | AMERIHEALTH MERCY - WSRH | OTHER | 50117701 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 50117701 | 01 | PA | CAPITAL BLUE CROSS - WMG - WS SURG, AND REHAB HOSP-PATHOLOGY | OTHER |