=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134121387
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALIQUIPPA COMMUNITY HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2005
-----------------------------------------------------
Last Update Date | 06/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 HOSPITAL DR
-----------------------------------------------------
City | ALIQUIPPA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15001-2123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-857-1212
-----------------------------------------------------
Fax | 724-857-1298
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2500 HOSPITAL DR
-----------------------------------------------------
City | ALIQUIPPA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15001-2123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-857-1212
-----------------------------------------------------
Fax | 724-857-1298
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. WILLIE L FELTS JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 724-857-1212
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 012601
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 012601
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------