Provider Demographics
NPI:1104143759
Name:YORK HEART AND VASCULAR SPECIALIST
Entity type:Organization
Organization Name:YORK HEART AND VASCULAR SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR CLIENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-882-3459
Mailing Address - Street 1:1600 6TH AVE
Mailing Address - Street 2:105
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-2626
Mailing Address - Country:US
Mailing Address - Phone:717-549-5450
Mailing Address - Fax:717-849-5755
Practice Address - Street 1:1600 6TH AVE
Practice Address - Street 2:105
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2626
Practice Address - Country:US
Practice Address - Phone:717-549-5450
Practice Address - Fax:717-849-5755
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL ENTERPRISES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD439156174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
039846Medicare PIN