Provider Demographics
NPI:1538263892
Name:PETER A HURTUBISE
Entity type:Organization
Organization Name:PETER A HURTUBISE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:HURTUBISE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-627-3133
Mailing Address - Street 1:1887 LITITZ PIKE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601
Mailing Address - Country:US
Mailing Address - Phone:717-627-3133
Mailing Address - Fax:717-569-3092
Practice Address - Street 1:1887 LITITZ PIKE
Practice Address - Street 2:SUITE 6
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601
Practice Address - Country:US
Practice Address - Phone:717-627-3133
Practice Address - Fax:717-569-3092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016661620003Medicaid
PAG54329Medicare UPIN