Healthcare Provider Details

I. General information

NPI: 1962444729
Provider Name (Legal Business Name): WARREN GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 LEE STREET
WARREN PA
16365-2114
US

IV. Provider business mailing address

2 CRESCENT PARK WEST
WARREN PA
16365-2111
US

V. Phone/Fax

Practice location:
  • Phone: 814-726-1786
  • Fax: 814-723-0414
Mailing address:
  • Phone: 814-723-3300
  • Fax: 814-723-8515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number490401
License Number StatePA

VIII. Authorized Official

Name: JULIE SNYDER
Title or Position: EXEC DIR FISCAL SERVICES
Credential:
Phone: 814-723-3300