Basic Information
| Provider Information | |||||||||
| NPI: | 1528061314 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SHAMOKIN AREA COMMUNITY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4200 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | COAL TOWNSHIP | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178669668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706444200 | ||||||||
| FaxNumber: | 5706444351 | ||||||||
| Practice Location | |||||||||
| Address1: | 4200 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | COAL TOWNSHIP | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178669668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706444200 | ||||||||
| FaxNumber: | 5706444351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 02/22/2011 | ||||||||
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| AuthorizedOfficialLastName: | MORRIS | ||||||||
| AuthorizedOfficialFirstName: | RANDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | V.P., CFO | ||||||||
| AuthorizedOfficialTelephone: | 5706444229 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | 196501 | PA | Y | Hospitals | General Acute Care Hospital | Rural |
ID Information
| ID | Type | State | Issuer | Description | 1007753070010 | 05 | PA | MEDICAID | 1516 | 01 | PA | HIGHMARK ACUTE | OTHER | 66283 | 01 | PA | MEDPLUS | OTHER | 74340 | 01 | PA | MEDPLUS | OTHER | 1007753070003 | 05 | PA | MEDICAID | 1012710001 | 01 | PA | HEALTH AMERICA | OTHER | 1501462 | 01 | PA | GATEWAY | OTHER | 1007753070009 | 05 | PA | MEDICAID | 25714 | 01 | PA | GEISINGER HEALTH PLAN | OTHER | 56136 | 01 | PA | MEDPLUS | OTHER | 1007753070004 | 05 | PA | MEDICAID | 030086400 | 01 | PA | FEDERAL BLACK LUNG PROGRA | OTHER | 56137 | 01 | PA | MEDPLUS | OTHER |