Basic Information
Provider Information | |||||||||
NPI: | 1811130438 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ALLE-KISKI MEDICAL CENTER | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ALLE-KISKI MEDICAL CENTER-REHABILITATION UNIT | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1301 CARLISLE ST | ||||||||
Address2: |   | ||||||||
City: | NATRONA HEIGHTS | ||||||||
State: | PA | ||||||||
PostalCode: | 150651152 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7242245100 | ||||||||
FaxNumber: | 7242267143 | ||||||||
Practice Location | |||||||||
Address1: | 1301 CARLISLE ST | ||||||||
Address2: |   | ||||||||
City: | NATRONA HEIGHTS | ||||||||
State: | PA | ||||||||
PostalCode: | 150651152 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7242245100 | ||||||||
FaxNumber: | 7242267143 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/13/2009 | ||||||||
LastUpdateDate: | 04/13/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | LAUBACHER | ||||||||
AuthorizedOfficialFirstName: | NED | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
AuthorizedOfficialTelephone: | 7242267000 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | ALLE-KISKI MEDICAL CENTER | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X |   |   | Y |   | Hospital Units | Rehabilitation Unit |   |
No ID Information.