Basic Information
| Provider Information | |||||||||
| NPI: | 1073606737 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DELAWARE COUNTY MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 NORTH LANSDOWNE AVENUE | ||||||||
| Address2: | |||||||||
| City: | DREXEL HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102848100 | ||||||||
| FaxNumber: | 6106197331 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 NORTH LANSDOWNE AVENUE | ||||||||
| Address2: | |||||||||
| City: | DREXEL HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102848100 | ||||||||
| FaxNumber: | 6106197331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 02/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | GAVIN | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 6103388225 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 041801 | PA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0001104000 | 01 | PA | IBC/KEYSTONE HEALTH PLAN EAST/AMERIHEALTH | OTHER | 1007725660016 | 05 | PA | MEDICAID | 390081 | 01 | PA | AARP | OTHER | 1007725660003 | 05 | PA | MEDICAID | 60012 | 01 | PA | HORIZON MERCY | OTHER | IY0111 | 01 | PA | BRAVO ELDERHEALTH/HEALTH NET | OTHER | 390081 | 01 | AMERIHEALTH TPA | OTHER | 390081 | 01 | PA | THREE RIVERS NETWORK | OTHER | 87726 | 01 | PA | UNITED HEALTHCARE | OTHER | 00011 | 01 | PA | HEALTH PARTNERS | OTHER | 1493 | 01 | PA | AETNA | OTHER | 25152 | 01 | PA | ADVANTRA FREEDOM | OTHER | 390081 | 01 | AMERIHEALTH DELCO | OTHER | 4191404 | 05 | NJ | MEDICAID | 60012 | 01 | PA | KEYSTONE MERCY HEALTH PLAN | OTHER | 62308 | 01 | PA | CIGNA | OTHER | H06015 | 01 | PA | OXFORD | OTHER | 0001493 | 01 | AUSHC | OTHER | 129502 | 01 | MAGELLAN | OTHER | 60012 | 01 | KEYSTONE MERCY HEALTH PLA | OTHER | 86033 | 01 | PA | CIGNA MEDICARE ACCESS | OTHER | 262730 | 01 | PA | MAMSI | OTHER | 390081 | 01 | PA | KINDRED HOSPITAL | OTHER |