1659472447 NPI number — TYRONE HOSPITAL

Table of content: (NPI 1659472447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659472447 NPI number — TYRONE HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TYRONE 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:
1659472447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
187 HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TYRONE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16686-1808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-684-1255
Provider Business Mailing Address Fax Number:
814-684-6395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
187 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TYRONE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16686-1808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-684-1255
Provider Business Practice Location Address Fax Number:
814-684-6395
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STRISHOCK
Authorized Official First Name:
JOURDAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
814-375-6160

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  46030101 , 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: 1007734000001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007734000002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10285 . This is a "MEDPLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 210987 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1019791 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0093 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 10940 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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