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General NPI Number Information
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NPI Number | 1184116774
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Entity Type | Organization
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Legal Business Name | SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 700 E NORWEGIAN ST
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City | POTTSVILLE
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State | PA
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Zip | 17901-2710
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Country | US
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Telephone | 570-621-5093
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Fax |
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Provider Business Mailing Address
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Address Line | 700 E NORWEGIAN ST
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City | POTTSVILLE
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State | PA
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Zip | 17901-2710
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Country | US
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Telephone | 570-621-5093
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT OF FINANCE
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Name | MS. DIANE N BORIS
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Credential |
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Telephone | 570-621-5093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 421001
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License Number State | PA
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