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General NPI Number Information
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NPI Number | 1104953702
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Entity Type | Organization
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Legal Business Name | CANONSBURG GENERAL HOSPITAL
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 400 SOUTHPOINTE BLVD PLAZA 1 SUITE235
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City | CANONSBURG
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State | PA
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Zip | 15317-8549
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Country | US
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Telephone | 724-743-1800
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Fax | 724-743-3291
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Provider Business Mailing Address
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Address Line | 400 SOUTHPOINTE BLVD PLAZA 1 SUITE235
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City | CANONSBURG
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State | PA
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Zip | 15317-8549
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Country | US
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Telephone | 724-743-1800
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Fax | 724-743-3291
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MR. TERRY WILTROUT
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Credential |
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Telephone | 724-873-5880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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