Healthcare Provider Details

I. General information

NPI: 1609851856
Provider Name (Legal Business Name): SHAMOKIN AREA COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 HOSPITAL RD
COAL TOWNSHIP PA
17866-9668
US

IV. Provider business mailing address

4200 HOSPITAL RD
COAL TOWNSHIP PA
17866-9668
US

V. Phone/Fax

Practice location:
  • Phone: 570-644-4200
  • Fax: 570-644-4351
Mailing address:
  • Phone: 570-644-4200
  • Fax: 570-644-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number930920
License Number StatePA

VIII. Authorized Official

Name: MR. RANDY MORRIS
Title or Position: V.P., CFO
Credential:
Phone: 570-644-4229