1902825896 NPI number — BLUE MOUNTAIN HOSPITAL

Table of content: MS. SANDRA KATHERYN PERRY RN (NPI 1699935155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902825896 NPI number — BLUE MOUNTAIN HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUE MOUNTAIN 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:
1902825896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 NORTH 12TH STREET
Provider Second Line Business Mailing Address:
FINANCE OFFICE
Provider Business Mailing Address City Name:
LEHIGHTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18235-1596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-377-7003
Provider Business Mailing Address Fax Number:
610-377-4758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 MAHONING ST SUITE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEHIGHTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18235-1246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-377-7157
Provider Business Practice Location Address Fax Number:
610-377-7926
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDRAE
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
610-377-7003

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  710505 , 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: 1004958310012 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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