MEDICARE: EASTERN REGIONAL MEDICAL CENTER, INC

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	284300000X	Special Hospital
2	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1538124698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN REGIONAL MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	3677 PAYSPHERE CIR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-0036
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1331 E WYOMING AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-3808
Country	:	US
Telephone Number	:	847-746-4358
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARIA SCENNA
Credential	:
Telephone Number	:	215-537-4979

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	03/25/2021

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