1245335629 NPI number — MAIN LINE HOSPITALS, INC.

Table of content: (NPI 1245335629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245335629 NPI number — MAIN LINE HOSPITALS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAIN LINE HOSPITALS, INC.
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:
1245335629
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 N RADNOR CHESTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RADNOR
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19087-5170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-337-1814
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E LANCASTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYNNEWOOD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19096-3450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-645-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUONGIORNO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
610-526-8480

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  120401 , 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: 0001019000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 912945600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00431470 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007354280039 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0001019000 . This is a "INDEPENDENCE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4197909 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60024 . This is a "KEYSTONE MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0001427 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000607205 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0071399204 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1007766910 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3025459 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 668399483A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 258210 . This is a "MAMSI/ALLIANCE" identifier . This identifiers is of the category "OTHER".




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