Provider Demographics
NPI:1104953702
Name:CANONSBURG GENERAL HOSPITAL
Entity type:Organization
Organization Name:CANONSBURG GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILTROUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-873-5880
Mailing Address - Street 1:400 SOUTHPOINTE BLVD
Mailing Address - Street 2:PLAZA 1 SUITE235
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-8549
Mailing Address - Country:US
Mailing Address - Phone:724-743-1800
Mailing Address - Fax:724-743-3291
Practice Address - Street 1:400 SOUTHPOINTE BLVD
Practice Address - Street 2:PLAZA 1 SUITE235
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-8549
Practice Address - Country:US
Practice Address - Phone:724-743-1800
Practice Address - Fax:724-743-3291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine