1457354672 NPI number — DLP CONEMAUGH MEMORIAL MEDICAL CENTER LLC

Table of content: (NPI 1457354672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457354672 NPI number — DLP CONEMAUGH MEMORIAL MEDICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DLP CONEMAUGH MEMORIAL MEDICAL CENTER LLC
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:
1457354672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 SEVEN SPRINGS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-4536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-920-7000
Provider Business Mailing Address Fax Number:
615-920-8913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 LOCUST ST
Provider Second Line Business Practice Location Address:
FIRST FLOOR SUITE
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15901-1651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-534-7500
Provider Business Practice Location Address Fax Number:
814-534-7501
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GIOVANETTI
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-920-7000

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  740605 , 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: 030014300 . This is a "FEDERAL BLACK LUNG ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 603577600 . This is a "OFFICE WORKERS COMP ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0785 . This is a "HIGHMARK BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007568490034 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1011895 . This is a "GATEWAY / MOM MATTERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1329770 . This is a "UMWA FUNDS ID #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PO08337 . This is a "CHAMPUS ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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