Healthcare Provider Details

I. General information

NPI: 1659315372
Provider Name (Legal Business Name): INDIANA REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 HOSPITAL RD SHORT PROCEDURE UNIT
INDIANA PA
15701-0788
US

IV. Provider business mailing address

835 HOSPITAL ROAD PO BOX 788
INDIANA PA
15701-0788
US

V. Phone/Fax

Practice location:
  • Phone: 724-357-7008
  • Fax: 724-357-7414
Mailing address:
  • Phone: 724-357-7008
  • Fax: 724-357-7414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number090701
License Number StatePA

VIII. Authorized Official

Name: MR. MICHAEL F ICKOWSKI
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA, MBA
Phone: 724-357-7008