Basic Information
| Provider Information | |||||||||
| NPI: | 1235138405 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LEHIGH VALLEY HOSPITAL SCHUYLKILL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LEHIGH VALLEY HOSPITAL SCHUYLKILL S JACKSON STREET | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4120 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181054120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4848840841 | ||||||||
| FaxNumber: | 4848843392 | ||||||||
| Practice Location | |||||||||
| Address1: | 420 S JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | POTTSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 179013625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706215000 | ||||||||
| FaxNumber: | 5706228221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2005 | ||||||||
| LastUpdateDate: | 10/10/2019 | ||||||||
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| AuthorizedOfficialLastName: | MARCHOZZI | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4848623943 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | N | Hospitals | General Acute Care Hospital | 282NR1301X | N | Hospitals | General Acute Care Hospital | Rural | 282NR1301X | 421001 | PA | Y | Hospitals | General Acute Care Hospital | Rural |
ID Information
| ID | Type | State | Issuer | Description | 100760725 | 05 | PA | MEDICAID | 39-0030 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 1497 | 01 | PA | HIGHMARK/BLUE SHIELD | OTHER |