Basic Information
| Provider Information | |||||||||
| NPI: | 1114549722 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GRAND VIEW HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GRAND VIEW HEALTH PHYSIATRY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 358 | ||||||||
| Address2: | |||||||||
| City: | SOUDERTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189640358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152573700 | ||||||||
| FaxNumber: | 2152570360 | ||||||||
| Practice Location | |||||||||
| Address1: | 915 LAWN AVE | ||||||||
| Address2: | |||||||||
| City: | SELLERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189601551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152573700 | ||||||||
| FaxNumber: | 2152570360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2020 | ||||||||
| LastUpdateDate: | 11/23/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | HUGHES | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2154534000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GRAND VIEW HOSPITAL | ||||||||
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| NPICertificationDate: | 11/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.