Provider Demographics
NPI:1003948761
Name:DLP CONEMAUGH MEYERSDALE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:DLP CONEMAUGH MEYERSDALE MEDICAL CENTER LLC
Other - Org Name:CONEMAUGH MEYERSDALE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4536
Mailing Address - Country:US
Mailing Address - Phone:615-920-7000
Mailing Address - Fax:615-920-8913
Practice Address - Street 1:200 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MEYERSDALE
Practice Address - State:PA
Practice Address - Zip Code:15552-1249
Practice Address - Country:US
Practice Address - Phone:814-634-5911
Practice Address - Fax:814-634-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA391101261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100770507 0009Medicaid