Provider Demographics
NPI:1528061314
Name:SHAMOKIN AREA COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:SHAMOKIN AREA COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P., CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-644-4229
Mailing Address - Street 1:4200 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:COAL TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:17866-9668
Mailing Address - Country:US
Mailing Address - Phone:570-644-4200
Mailing Address - Fax:570-644-4351
Practice Address - Street 1:4200 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:COAL TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:17866-9668
Practice Address - Country:US
Practice Address - Phone:570-644-4200
Practice Address - Fax:570-644-4351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA196501282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007753070010Medicaid
PA1516OtherHIGHMARK ACUTE
PA66283OtherMEDPLUS
PA74340OtherMEDPLUS
PA1007753070003Medicaid
PA1012710001OtherHEALTH AMERICA
PA1501462OtherGATEWAY
PA1007753070009Medicaid
PA25714OtherGEISINGER HEALTH PLAN
PA56136OtherMEDPLUS
PA1007753070004Medicaid
PA030086400OtherFEDERAL BLACK LUNG PROGRA
PA56137OtherMEDPLUS
PA56137OtherMEDPLUS