1215042114 NPI number — MAIN LINE HOSPITALS, INC.

Table of content: (NPI 1215042114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215042114 NPI number — MAIN LINE HOSPITALS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAIN LINE HOSPITALS, 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:
PAOLI HOSPITAL
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:
1215042114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3803 W CHESTER PIKE STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTOWN SQUARE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19073-2336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-337-1814
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 W LANCASTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAOLI
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19301-1763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-648-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUONGIORNO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
484-337-8480

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  161801 , 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: 0001107000 . This is a "INDEPENDENCE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0001452 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00739235 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0520842 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 912945600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000162588X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003035466 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100727794 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00545046-02 . This is a "AMERICHOICE MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 019182700 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08310 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60039 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0000899205 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 013745600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007354280036 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0001107000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4195400 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1024887 . This is a "AETNA HMO & MEDICARE CAP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 258208 . This is a "MAMSI/ALLIANCE PPO" identifier . This identifiers is of the category "OTHER".




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