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Organization
WELLSPAN MEDICAL GROUP
Active
Organization
WELLSPAN MEDICAL GROUP
Active
Other names
Wellspan Readycare
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMY F WILKINSON (CREDENTIALING COORDINATOR)
(717) 851-1405
Entity
Organization
Contact information
Practice address
1101 EDGAR ST, SUITE E, YORK, PA 17403-2862
(717) 851-1566
(717) 851-1569
Mailing address
1803 MOUNT ROSE AVE, SUITE B3, YORK, PA 17403-3051
(717) 851-1405
(717) 851-1569
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007721360261
—
PA
01
—
1874423
HIGHMARK WELLSPAN MG
PA
01
—
19WW
CAREFIRST BCBS
MD
01
—
20054647
AMERIHEALTH MERCY
PA
01
—
417T
GEISINGER
PA
01
—
50062674
CAPITAL BLUE CROSS
PA
01
—
7594870
AETNA
PA
01
—
800174
JOHN HOPKINS WELLSPAN MG
PA
01
—
CA3246
RAILROAD MEDICARE
PA
Enumeration date
09/20/2006
Last updated
08/11/2010
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