1053496893 NPI number — DLP CONEMAUGH MEMORIAL MEDICAL CENTER LLC

Table of content: (NPI 1053496893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053496893 NPI number — DLP CONEMAUGH MEMORIAL MEDICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DLP CONEMAUGH MEMORIAL MEDICAL CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEMORIAL BEHAVIORAL HEALTH UNIT - GERO
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053496893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 SEVEN SPRINGS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-4536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-920-7000
Provider Business Mailing Address Fax Number:
615-920-8913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 FRANKLIN ST
Provider Second Line Business Practice Location Address:
8TH FLOOR
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15905-4109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-534-1980
Provider Business Practice Location Address Fax Number:
814-534-1810
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DILLON
Authorized Official First Name:
TERRANCE
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT SECRETARY
Authorized Official Telephone Number:
502-596-7220

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  035601 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0148 . This is a "BLUE CROSS PSYCH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 100756849 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 789567 . This is a "PROFEE PSYCH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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