Provider Demographics
NPI:1194868729
Name:JERSEY SHORE HOSPITAL
Entity type:Organization
Organization Name:JERSEY SHORE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-398-3100
Mailing Address - Street 1:1020 THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY SHORE
Mailing Address - State:PA
Mailing Address - Zip Code:17740-1729
Mailing Address - Country:US
Mailing Address - Phone:570-398-0100
Mailing Address - Fax:570-398-4412
Practice Address - Street 1:1020 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:JERSEY SHORE
Practice Address - State:PA
Practice Address - Zip Code:17740-1729
Practice Address - Country:US
Practice Address - Phone:570-398-0100
Practice Address - Fax:570-398-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101401261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10011OtherGEISINGER
PA391300OtherBLUE CROSS
PA59746OtherAETNA
PA391300OtherWORKERS COMP
PA009912OtherFIRST PRIORITY
PA1007703560018Medicaid
PA5511OtherHEALTH AMERICA
PA391300OtherRR MEDICARE
PA5511OtherHEALTH AMERICA