| Jackson Siegelbaum Gastroenterology Ltd | |
|
423 N 21st St Suite 100 Camp Hill PA 17011-2207 | |
| (717) 761-0930 | |
| (717) 761-0465 |
| Full Name | Jackson Siegelbaum Gastroenterology Ltd |
|---|---|
| Speciality | Internal Medicine |
| Location | 423 N 21st St, Camp Hill, Pennsylvania |
| Authorized Official Name and Position | Frank Wilson Jackson (PRESIDENT) |
| Authorized Official Contact | 7177610930 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Siegelbaum Gastroenterology Ltd 423 N 21st St Suite 100 Camp Hill PA 17011-2207 Ph: (717) 761-0930 | Jackson Siegelbaum Gastroenterology Ltd 423 N 21st St Suite 100 Camp Hill PA 17011-2207 Ph: (717) 761-0930 |
| NPI Number | 1902866205 |
|---|---|
| Provider Enumeration Date | 03/23/2006 |
| Last Update Date | 10/22/2007 |
| Medicare PECOS PAC ID | 5799769139 |
|---|---|
| Medicare Enrollment ID | O20040615000390 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902866205 | NPI | - | NPPES |
| CM8555 | Other | PA | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Frank Wilson Jackson |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1164421673 PECOS PAC ID: 1456310432 Enrollment ID: I20050512000016 |
| Provider Name | Charles David Evancho |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1932194644 PECOS PAC ID: 7719908466 Enrollment ID: I20051209000567 |
| Provider Name | Henry J Venbrux |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1851389894 PECOS PAC ID: 2567483027 Enrollment ID: I20051212000707 |
| Provider Name | Paul G Lacey |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1265432876 PECOS PAC ID: 1850303819 Enrollment ID: I20060613000101 |
| Provider Name | Adnan Ahmad |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1215917190 PECOS PAC ID: 7012984495 Enrollment ID: I20070821000268 |
| Provider Name | Junyi Lei |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1689606659 PECOS PAC ID: 9032207683 Enrollment ID: I20071114000462 |
| Provider Name | John J Michel |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1902805971 PECOS PAC ID: 1951408939 Enrollment ID: I20101104001194 |
| Provider Name | Subhar Banerjee |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1043478407 PECOS PAC ID: 2567586902 Enrollment ID: I20121120000104 |
| Provider Name | Tyson Collazo |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1801195565 PECOS PAC ID: 4688941735 Enrollment ID: I20200403000028 |
| Provider Name | Babatunde R Olaiya |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1659895282 PECOS PAC ID: 8628312691 Enrollment ID: I20231019000781 |
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