Provider Demographics
NPI:1285726950
Name:DEPARTMENT OF MILITARY AFFAIRS COMMONWEALTH OF PENNSYLVANIA
Entity type:Organization
Organization Name:DEPARTMENT OF MILITARY AFFAIRS COMMONWEALTH OF PENNSYLVANIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FISCAL SERVICES ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:814-242-7789
Mailing Address - Street 1:1 VETERANS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:PA
Mailing Address - Zip Code:19475-1241
Mailing Address - Country:US
Mailing Address - Phone:610-948-2603
Mailing Address - Fax:610-948-2461
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:
Practice Address - City:SPRING CITY
Practice Address - State:PA
Practice Address - Zip Code:19475-1241
Practice Address - Country:US
Practice Address - Phone:610-948-2603
Practice Address - Fax:610-948-2461
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPARTMENT OF MILITARY AFFAIRS COMMONWEALTH OF PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-29
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4260022865M2000X, 314000000X
311Z00000X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA099810Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER