1396769782 NPI number — WVHCS-HOSPITAL

Table of content: (NPI 1396769782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396769782 NPI number — WVHCS-HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WVHCS-HOSPITAL
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:
WILKES-BARRE GENERAL 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:
1396769782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
575 N RIVER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILKES BARRE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18764-0999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-829-8111
Provider Business Mailing Address Fax Number:
570-552-3030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
575 N RIVER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18764-0999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-829-8111
Provider Business Practice Location Address Fax Number:
570-552-3030
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KOEHLER
Authorized Official First Name:
MAGGIE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
SENIOR VP/CFO
Authorized Official Telephone Number:
570-552-3023

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  234501 , 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: 0299 . This is a "FREEDOM BLUE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1024614 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1024614 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 68767 . This is a "UNISON MANAGED CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1008143800001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56307 . This is a "UNISON MANAGED CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 390137 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 080570 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1008143800008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 390137 . This is a "STERLING" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 6491500 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 68767 . This is a "UNISON ADVANTAGE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: IY0034 . This is a "HEALTHNET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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