Basic Information
| Provider Information | |||||||||
| NPI: | 1184799249 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ARMSTRONG COUNTY MEMORIAL HOSPITAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ARMSTRONG PRIMARY CARE CENTER ELDERTON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 579 | ||||||||
| Address2: | |||||||||
| City: | KITTANNING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 162010579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245438164 | ||||||||
| FaxNumber: | 7245438616 | ||||||||
| Practice Location | |||||||||
| Address1: | 116 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | ELDERTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243545258 | ||||||||
| FaxNumber: | 7243544396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2006 | ||||||||
| LastUpdateDate: | 01/28/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 07/17/2007 | ||||||||
| NPIReactivationDate: | 07/31/2007 | ||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BURNS | ||||||||
| AuthorizedOfficialFirstName: | PAT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP OF FINANCE CFO | ||||||||
| AuthorizedOfficialTelephone: | 7245438618 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 530183 | 01 | PA | AETNA PEDIATRICS | OTHER | 898783 | 01 | PA | BLUE SHIELD | OTHER | 585472 | 01 | PA | AETNA ADULT CARE | OTHER | 1012923 | 01 | PA | GATEWAY | OTHER | 70001 | 01 | PA | UNISON | OTHER | 1007459070026 | 05 | PA | MEDICAID |