1306989967 NPI number — JERSEY SHORE HOSPITAL

Table of content: (NPI 1306989967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306989967 NPI number — JERSEY SHORE HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JERSEY SHORE 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:
JSECPA
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:
1306989967
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020 THOMPSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JERSEY SHORE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17740-1729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-398-0100
Provider Business Mailing Address Fax Number:
570-398-4412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 THOMPSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY SHORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17740-1729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-398-0100
Provider Business Practice Location Address Fax Number:
570-398-4412
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
O'NEILL
Authorized Official First Name:
MARK
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
570-398-3100

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  101401 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 101401 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 101401 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 101401 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: 101401 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 101401 , 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: 222070 . This is a "RADIOLOGY FPH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 391300 . This is a "WORKERS COMP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007703560004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 230275 . This is a "HA RADIOLOGY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3634 . This is a "GHP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: C10719 . This is a "RR MEDICARE DR GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 116482 . This is a "HA ER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 139690 . This is a "HA ANESTHSIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 222069 . This is a "ER FPH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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