Healthcare Provider Details

I. General information

NPI: 1548761935
Provider Name (Legal Business Name): THE CARBON-SCHUYLKILL COMMUNITY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 11/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 S SHENANDOAH RD
RINGTOWN PA
17967-9432
US

IV. Provider business mailing address

411 S SHENANDOAH RD
RINGTOWN PA
17967-9432
US

V. Phone/Fax

Practice location:
  • Phone: 570-645-1951
  • Fax: 570-645-1952
Mailing address:
  • Phone: 570-645-1951
  • Fax: 570-645-1952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THOMAS LICHTENWALNER
Title or Position: SR. VICE PRESIDENT
Credential:
Phone: 484-526-3301