Basic Information
| Provider Information | |||||||||
| NPI: | 1851467765 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ARMSTRONG COUNTY MEMORIAL HOSPITAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | ACMH HOSPITAL PSYCHIATRIC | ||||||||
| 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: | 1 NOLTE DR | ||||||||
| Address2: | |||||||||
| City: | KITTANNING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 162017111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245438164 | ||||||||
| FaxNumber: | 7245438616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 09/28/2007 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BURNS | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF FINANCE CFO | ||||||||
| AuthorizedOfficialTelephone: | 7245438168 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 940370 | PA | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | 0904 | 01 | PA | BLUE CROSS | OTHER | 1007459070015 | 05 | PA | MEDICAID |