Provider Demographics
NPI:1427050376
Name:SCHUYLKILL MEDICAL CENTER - EAST NORWEIGAN STREET
Entity type:Organization
Organization Name:SCHUYLKILL MEDICAL CENTER - EAST NORWEIGAN STREET
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIMODEJKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-621-5111
Mailing Address - Street 1:700 E NORWEGIAN ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-2710
Mailing Address - Country:US
Mailing Address - Phone:570-621-4143
Mailing Address - Fax:570-621-4769
Practice Address - Street 1:700 E NORWEGIAN ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2710
Practice Address - Country:US
Practice Address - Phone:570-621-4143
Practice Address - Fax:570-621-4769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA590201282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2356OtherAETNA INSURANCE PLANS
PA60546OtherKEYSTONE MERCY
PA10048OtherGEISINGER HEALTH PLANS
PA1007604490030Medicaid
PA1007604490031Medicaid
PA1007604490029Medicaid
PA66815OtherMEDPLUS THREE RIVERS HMO
PA1440OtherHIGHMARK BLUE SHIELD
PA7390031OtherGATEWAY MEDICAID HMO
PA390031Medicare ID - Type Unspecified