1073538963 NPI number — LATROBE AREA HOSPITAL, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073538963 NPI number — LATROBE AREA HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LATROBE AREA HOSPITAL, INC.
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:
BLAIRSVILLE FAMILY MEDICINE
Provider Other Organization Name Type Code:
5
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:
1073538963
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
134 INDUSTRIAL PARK RD
Provider Second Line Business Mailing Address:
STE 2300A
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-7328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-689-1835
Provider Business Mailing Address Fax Number:
724-850-8096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56 CLUB LN
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
BLAIRSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15717-7957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-459-5203
Provider Business Practice Location Address Fax Number:
724-459-0949
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DISHONG
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
VICE PRESIDENT/EXEC DIR - EHPP
Authorized Official Telephone Number:
724-830-8500

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 797869 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 100761052 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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