Basic Information
| Provider Information | |||||||||
| NPI: | 1821198755 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GEISINGER BLOOMSBURG HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE BLOOMSBURG HOSPITAL | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N ACADEMY AVE | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178224903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702716211 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 549 FAIR ST | ||||||||
| Address2: | |||||||||
| City: | BLOOMSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178151419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703872100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 08/05/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MULL | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | SYSTEM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5702716603 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 282NC0060X | N | Hospitals | General Acute Care Hospital | Critical Access | 282NC2000X | N | Hospitals | General Acute Care Hospital | Children | 282NR1301X | N | Hospitals | General Acute Care Hospital | Rural | 282NW0100X | N | Hospitals | General Acute Care Hospital | Women | 286500000X | N | Hospitals | Military Hospital | 2865M2000X | N | Hospitals | Military Hospital | Military General Acute Care Hospital | 282N00000X | 025001 | PA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1007740410009 | 05 | PA | MEDICAID |