Provider Demographics
NPI:1073538963
Name:LATROBE AREA HOSPITAL, INC.
Entity Type:Organization
Organization Name:LATROBE AREA HOSPITAL, INC.
Other - Org Name:BLAIRSVILLE FAMILY MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT/EXEC DIR - EHPP
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DISHONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-830-8500
Mailing Address - Street 1:134 INDUSTRIAL PARK RD
Mailing Address - Street 2:STE 2300A
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-7328
Mailing Address - Country:US
Mailing Address - Phone:724-689-1835
Mailing Address - Fax:724-850-8096
Practice Address - Street 1:56 CLUB LN
Practice Address - Street 2:STE 102
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717-7957
Practice Address - Country:US
Practice Address - Phone:724-459-5203
Practice Address - Fax:724-459-0949
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LATROBE AREA HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-13
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA797869OtherHIGHMARK
PA100761052Medicaid
PA797869OtherHIGHMARK