Healthcare Provider Details

I. General information

NPI: 1790504132
Provider Name (Legal Business Name): WARREN GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W CRESCENT PARK
WARREN PA
16365-2199
US

IV. Provider business mailing address

2 W CRESCENT PARK
WARREN PA
16365-2111
US

V. Phone/Fax

Practice location:
  • Phone: 814-723-3300
  • Fax: 814-723-8515
Mailing address:
  • Phone: 814-723-3300
  • Fax: 814-723-8515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA M RISTAU
Title or Position: DIRECTOR OF PATIENT ACCOUNTS
Credential:
Phone: 814-723-4973