1891763249 NPI number — JEFFERSON REGIONAL MEDICAL CENTER

Table of content: (NPI 1891763249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891763249 NPI number — JEFFERSON REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERSON REGIONAL MEDICAL CENTER
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:
JEFFERSON HOSPITAL COUNSELING SERVICES
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:
1891763249
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
810 CLAIRTON BLVD STE 500600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15236-5505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-650-1100
Provider Business Mailing Address Fax Number:
412-650-1101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
810 CLAIRTON BLVD STE 500600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15236-5505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-650-1100
Provider Business Practice Location Address Fax Number:
412-650-1101
Provider Enumeration Date:
03/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NOEL
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR PROVIDER ENROLLMENT
Authorized Official Telephone Number:
412-330-5861

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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