1467510560 NPI number — EAGLEVILLE HOSPITAL

Table of content: (NPI 1467510560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467510560 NPI number — EAGLEVILLE HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAGLEVILLE 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:
Provider Other Organization Name Type Code:
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:
1467510560
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 EAGLEVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAGLEVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19403-1829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-539-6000
Provider Business Mailing Address Fax Number:
610-539-6249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 EAGLEVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAGLEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19403-1829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-539-6000
Provider Business Practice Location Address Fax Number:
610-539-6249
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCGLONE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR FINANCE
Authorized Official Telephone Number:
267-291-2210

Provider Taxonomy Codes

  • Taxonomy code: 276400000X , with the licence number:  051001 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282N00000X , with the licence number: 051001 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 284300000X , with the licence number: 051001 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1007779290003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106359 . This is a "CBH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: EAGL1977 . This is a "COMPREHENSIVE BEHAV CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 128150 . This is a "MBH OF PA, INC." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001185000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 004418000 . This is a "MAGELLAN BEHAVIORAL HLTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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