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General NPI Number Information
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NPI Number | 1306989967
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Entity Type | Organization
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Legal Business Name | JERSEY SHORE HOSPITAL
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 10/27/2007
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Provider Practice Location Address
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Address Line | 1020 THOMPSON ST
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City | JERSEY SHORE
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State | PA
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Zip | 17740-1729
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Country | US
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Telephone | 570-398-0100
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Fax | 570-398-4412
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Provider Business Mailing Address
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Address Line | 1020 THOMPSON ST
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City | JERSEY SHORE
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State | PA
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Zip | 17740-1729
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Country | US
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Telephone | 570-398-0100
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Fax | 570-398-4412
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Authorized Official
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Title or Position | CFO
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Name | MARK A. O'NEILL
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Credential |
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Telephone | 570-398-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 101401
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 101401
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 101401
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 101401
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 101401
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License Number State | PA
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Taxonomy #6
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 101401
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License Number State | PA
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