1083950687 NPI number — HANOVER HEALTH CORPORATION

Table of content: (NPI 1083950687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083950687 NPI number — HANOVER HEALTH CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HANOVER HEALTH CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HANOVER MEDICAL GROUP EXPRESS CARE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083950687
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 STOCK ST
Provider Second Line Business Mailing Address:
SUITE 7
Provider Business Mailing Address City Name:
HANOVER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17331-2276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-633-8858
Provider Business Mailing Address Fax Number:
717-316-2240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1404 BALTIMORE ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
HANOVER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17331-8698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-637-0470
Provider Business Practice Location Address Fax Number:
717-637-4987
Provider Enumeration Date:
12/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GASKINS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
717-646-4120

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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