Provider Demographics
NPI:1316481989
Name:JEFFERSON REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:JEFFERSON REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:TISCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-330-6062
Mailing Address - Street 1:565 COAL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:565 COAL VALLEY RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3703
Practice Address - Country:US
Practice Address - Phone:412-469-5266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLEGHENY HEALTH NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-15
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336I0012X
PAHP418183L3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy