1427050376 NPI number — SCHUYLKILL MEDICAL CENTER - EAST NORWEIGAN STREET

Table of content: (NPI 1427050376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427050376 NPI number — SCHUYLKILL MEDICAL CENTER - EAST NORWEIGAN STREET

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHUYLKILL MEDICAL CENTER - EAST NORWEIGAN STREET
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:
GOOD SAMARITAN REGIONAL MEDICAL CENTER
Provider Other Organization Name Type Code:
4
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:
1427050376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 E NORWEGIAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POTTSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17901-2710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-621-4143
Provider Business Mailing Address Fax Number:
570-621-4769

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 E NORWEGIAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POTTSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17901-2710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-621-4143
Provider Business Practice Location Address Fax Number:
570-621-4769
Provider Enumeration Date:
08/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SIMODEJKA
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
570-621-5111

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  590201 , 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: 2356 . This is a "AETNA INSURANCE PLANS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 60546 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 10048 . This is a "GEISINGER HEALTH PLANS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007604490030 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007604490031 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007604490029 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 66815 . This is a "MEDPLUS THREE RIVERS HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1440 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7390031 . This is a "GATEWAY MEDICAID HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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