Provider Demographics
NPI:1104872936
Name:WINDBER HOSPITAL, INC.
Entity type:Organization
Organization Name:WINDBER HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:KURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-467-3702
Mailing Address - Street 1:1511 SCALP AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3315
Mailing Address - Country:US
Mailing Address - Phone:814-254-4207
Mailing Address - Fax:814-254-4733
Practice Address - Street 1:1511 SCALP AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3315
Practice Address - Country:US
Practice Address - Phone:814-254-4207
Practice Address - Fax:814-254-4733
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINDBER HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-25
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060939L207Q00000X
PAMD434855207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1794402OtherHIGHMARK
PA1007703740019Medicaid
PA102114Medicare PIN