1093716060 NPI number — MONSOUR MEDICAL CENTER

Table of content: (NPI 1093716060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093716060 NPI number — MONSOUR MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONSOUR MEDICAL CENTER
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:
1093716060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 LINCOLN HWY E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEANNETTE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15644-3141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-527-1511
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 LINCOLN HWY E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEANNETTE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15644-3141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-526-1511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KAMINSKY
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
INTERIM CEO
Authorized Official Telephone Number:
724-527-0604

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  136501 , 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: 0976 . This is a "B. CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 205331 . This is a "UPMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25179 . This is a "COMMUNITY CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 333690 . This is a "VBH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 56148 . This is a "MED PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0124 . This is a "B. CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 333690 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1132 . This is a "B. CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 154215 . This is a "MED PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 326993A . This is a "VBH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 326993A . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 679835 . This is a "B. CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0147 . This is a "B. CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7102000 PA 15644 . This is a "BCOFMI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1006210 . This is a "GATEWAY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 56142 . This is a "MED PLUS" identifier . This identifiers is of the category "OTHER".




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