1124456157 NPI number — TYRONE HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124456157 NPI number — TYRONE HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TYRONE 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:
6
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:
1124456157
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
187 HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TYRONE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16686-1808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-375-4200
Provider Business Mailing Address Fax Number:
814-375-4232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUTZDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16651-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-497-4297
Provider Business Practice Location Address Fax Number:
814-497-4312
Provider Enumeration Date:
10/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KLINE
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
VP FINANCIAL AFFAIRS
Authorized Official Telephone Number:
814-375-6377

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100773400-0026 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 393427 . This is a "PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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