1992729503 NPI number — MT BETHEL MEDICAL CENTER LLC

Table of content: (NPI 1992729503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992729503 NPI number — MT BETHEL MEDICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MT BETHEL 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:
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:
1992729503
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 43
Provider Second Line Business Mailing Address:
10 MOUNT BETHEL PLAZA
Provider Business Mailing Address City Name:
MOUNT BETHEL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18343-0043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-897-7559
Provider Business Mailing Address Fax Number:
570-897-7567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 MOUNT BETHEL PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT BETHEL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18343-5212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-897-7559
Provider Business Practice Location Address Fax Number:
570-897-7567
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RASO
Authorized Official First Name:
JON
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO MOUNT BETHEL MEDICAL CENTER LLC
Authorized Official Telephone Number:
570-897-7559

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD053686L , 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: 110130795 . This is a "PALMETTO GBA - RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50017380 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1512446 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5843921 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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