1679579262 NPI number — MARIAN COMMUNITY HOSPITAL

Table of content: (NPI 1679579262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679579262 NPI number — MARIAN COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIAN 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:
1679579262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 LINCOLN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARBONDALE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18407-2116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 LINCOLN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18407-2116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-281-1009
Provider Business Practice Location Address Fax Number:
570-281-1029
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PATIENT FINANCIAL SERVI
Authorized Official Telephone Number:
570-281-1009

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  450801 , 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: 007207 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 14906 . This is a "GEISINGER HOSPITAL CLAIMS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 56119 . This is a "THREE RIVERS SPU" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007599490021 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007599490025 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10075994915 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 73816 . This is a "THREE RIVERS ED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 390095 . This is a "BLUE CROSS HOSPITAL CLAIM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 68688 . This is a "THREE RIVERS IP/OP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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