1396850368 NPI number — MAIN LINE HOSPITALS, INC.

Table of content: (NPI 1396850368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396850368 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:
1396850368
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:
484-337-1816
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
414 PAOLI PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MALVERN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19355-3311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-596-5400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EHRLICH
Authorized Official First Name:
LEIGH
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
484-337-2029

Provider Taxonomy Codes

  • Taxonomy code: 283X00000X , with the licence number:  540201 , 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: 100770006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4205707 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00838 . This is a "CHAMPUS TRICARE NORTH REG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0001121 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0524895 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01136121 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 258209 . This is a "MAMSI/ALLIANCE PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000066905 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08382 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1007354280038 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0001063000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00557261-01 . This is a "AMERICHOICE-MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0078104301 . This is a "AMERICHOICE HMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 17000060 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0001063000 . This is a "KEYSTONE 65" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001063000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 60088 . This is a "KEYSTONE MERCY" identifier . This identifiers is of the category "OTHER".




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