Healthcare Provider Details

I. General information

NPI: 1790999837
Provider Name (Legal Business Name): WINDBER HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SOMERSET AVE
WINDBER PA
15963-1331
US

IV. Provider business mailing address

600 SOMERSET AVE
WINDBER PA
15963-1331
US

V. Phone/Fax

Practice location:
  • Phone: 814-467-3000
  • Fax: 814-467-3407
Mailing address:
  • Phone: 814-467-3000
  • Fax: 814-467-3407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number234901
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW BOUCH
Title or Position: DIRECTOR OF PATIENT ACCOUNTING
Credential:
Phone: 814-467-3195