1720162878 NPI number — DIVINE PROVIDENCE HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY

Table of content: (NPI 1720162878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720162878 NPI number — DIVINE PROVIDENCE HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIVINE PROVIDENCE HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY
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:
DIVINE PROVIDENCE HOSPITAL
Provider Other Organization Name Type Code:
5
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:
1720162878
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1205 GRAMPIAN BLVD
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
WILLIAMSPORT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17701-1978
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-326-8676
Provider Business Mailing Address Fax Number:
570-326-8601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 GRAMPIAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17701-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-326-8000
Provider Business Practice Location Address Fax Number:
570-326-8601
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANTANGELO
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
J
Authorized Official Title or Position:
EXECUTIVE VP CFO
Authorized Official Telephone Number:
570-321-3171

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  041001 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 041001 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 283Q00000X , with the licence number: 041001 , 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: 1007563750020 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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