Provider Demographics
NPI:1548354509
Name:LANCASTER COUNTY INTERNAL MEDICINE, INC.
Entity type:Organization
Organization Name:LANCASTER COUNTY INTERNAL MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-397-7066
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584-0309
Mailing Address - Country:US
Mailing Address - Phone:717-397-7066
Mailing Address - Fax:717-397-7005
Practice Address - Street 1:1725 OREGON PIKE # A
Practice Address - Street 2:SUITE 104
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4206
Practice Address - Country:US
Practice Address - Phone:717-397-7066
Practice Address - Fax:717-397-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-006313L207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017314850004Medicaid
PA112458Medicare PIN