Provider Demographics
NPI:1194730556
Name:DLP CONEMAUGH MEMORIAL MEDICAL CENTER LLC
Entity type:Organization
Organization Name:DLP CONEMAUGH MEMORIAL MEDICAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:E
Authorized Official - Last Name:GIOVANETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4536
Mailing Address - Country:US
Mailing Address - Phone:615-920-7000
Mailing Address - Fax:615-920-8913
Practice Address - Street 1:315 LOCUST ST
Practice Address - Street 2:SUITE 5E
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1651
Practice Address - Country:US
Practice Address - Phone:814-534-6100
Practice Address - Fax:814-534-6105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA156599251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PO29291OtherCHAMPUS
PA242848OtherUNISON
PA87OtherUPMC
PA001491870Medicaid
PAHIGHMARK - 1024OtherHOSPICE
0124863OtherCIGNA
PAGATEWAY - 1502289OtherHOSPICE
PA001491870Medicaid