1124076039 NPI number — EVANGELICAL COMMUNITY HOSPITAL

Table of content: (NPI 1124076039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124076039 NPI number — EVANGELICAL COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVANGELICAL COMMUNITY 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:
1124076039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE HOSPITAL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17837-9350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-522-2000
Provider Business Mailing Address Fax Number:
570-768-3904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17837-9314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-522-2000
Provider Business Practice Location Address Fax Number:
570-522-2069
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AUCKER
Authorized Official First Name:
KENDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
570-522-2501

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  570201 , 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: 1007731510008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12800 . This is a "GHP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 390013 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007731510021 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8769 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1513 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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