Masonic Villages of the Grand Lodge of Pennsylvania

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

000634A Issued in PA

Legal business name

MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA

Practice address

581 Freemason Dr
Elizabethtown, PA 17022-3187

Phone

(717) 367-1121

Fax

(717) 367-5813

NPI assigned

Oct 25, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Pamela Formica

Title

Chief Financial Officer

Phone

(717) 367-1121

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682899200000",
    "number": "1972856151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MASONIC DR",
            "city": "ELIZABETHTOWN",
            "state": "PA",
            "postal_code": "170222199",
            "telephone_number": "717-367-1121",
            "fax_number": "717-367-5813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "581 FREEMASON DR",
            "city": "ELIZABETHTOWN",
            "state": "PA",
            "postal_code": "170223187",
            "telephone_number": "717-367-1121",
            "fax_number": "717-367-5813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-25",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A",
        "authorized_official_last_name": "FORMICA",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "717-367-1121",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PA",
            "license": "000634A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD PIN",
            "identifier": "220002197",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "39D0657302",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carolina Martinez
• Masonic Villages of the Grand Lodge of Pennsylvania
• Masonic Villages of the Grand Lodge of Pennsylvania
• Masonic Villages of the Grand Lodge of Pennsylvania
• Masonic Villages of the Grand Lodge of Pennsylvania
• John J Mast, M.D.
• Rana Lynn Mathias, DDS
• Brianne Alyssa Mayhue, OTR/L
• Margaret Lauren McFarland
• Corrine McGrail

• Clinical Medical Laboratory in Elizabethtown, PA
• Providers in Elizabethtown, PA by specialty
• Clinical Medical Laboratory in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.