Basic Information
| Provider Information | |||||||||
| NPI: | 1861469355 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KELLER ARMY COMMUNITY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 HAP ARNOLD BLVD | ||||||||
| Address2: | HEALTH CLINIC | ||||||||
| City: | TOBYHANNA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184665002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708956242 | ||||||||
| FaxNumber: | 5708956783 | ||||||||
| Practice Location | |||||||||
| Address1: | 11 HAP ARNOLD BLVD | ||||||||
| Address2: | HEALTH CLINIC | ||||||||
| City: | TOBYHANNA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184665002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708956242 | ||||||||
| FaxNumber: | 5708956783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BASTIANELLI | ||||||||
| AuthorizedOfficialFirstName: | ITALO | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DCCS | ||||||||
| AuthorizedOfficialTelephone: | 8549386940 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | MD013443E | PA | Y | Hospital Units | Rehabilitation Unit |
No ID Information.