MEDICARE: INDIANA REGIONAL MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	283X00000X	Rehabilitation Hospital
2	273Y00000X	Rehabilitation Hospital Unit

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001841	OTHER	PA	HIGHMARK

General Provider Information

NPI Number	:	1518950674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA REGIONAL MEDICAL CENTER

Provider Business Mailing Address
First Line	:	835 HOSPITAL RD
Second Line	:	PO BOX 788
City	:	INDIANA
State	:	PA
Zip	:	15701-3629
Country	:	US
Telephone Number	:	724-357-7008
Fax Number	:	724-357-7414

Provider Business Practice Location Address
First Line	:	835 HOSPITAL RD
Second Line	:	REHAB CARE CENTER
City	:	INDIANA
State	:	PA
Zip	:	15701-3629
Country	:	US
Telephone Number	:	724-357-7008
Fax Number	:	724-357-7414

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. MICHAEL F ICKOWSKI
Credential	:	CPA, MBA
Telephone Number	:	724-357-7008

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	07/10/2024

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Directions to “INDIANA REGIONAL MEDICAL CENTER ” Practice Location

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