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General NPI Number Information
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NPI Number | 1366790750
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Entity Type | Organization
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Legal Business Name | INDIANA REGIONAL MEDICAL CENTER
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 835 HOSPITAL RD URGICARE AT IRMC
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City | INDIANA
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State | PA
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Zip | 15701-3629
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Country | US
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Telephone | 724-357-7493
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Fax | 724-357-6961
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Provider Business Mailing Address
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Address Line | PO BOX 788 835 HOSPITAL ROAD
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City | INDIANA
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State | PA
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Zip | 15701-0788
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Country | US
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Telephone | 724-357-7493
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Fax | 724-357-6961
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. MICHAEL F ICKOWSKI
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Credential | CPA, MBA
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Telephone | 724-357-7008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 090701
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 090701
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License Number State | PA
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