Provider Demographics
NPI:1073606737
Name:DELAWARE COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DELAWARE COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-338-8225
Mailing Address - Street 1:501 NORTH LANSDOWNE AVENUE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026
Mailing Address - Country:US
Mailing Address - Phone:610-284-8100
Mailing Address - Fax:610-619-7331
Practice Address - Street 1:501 NORTH LANSDOWNE AVENUE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026
Practice Address - Country:US
Practice Address - Phone:610-284-8100
Practice Address - Fax:610-619-7331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA041801282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001104000OtherIBC/KEYSTONE HEALTH PLAN EAST/AMERIHEALTH
PA1007725660016Medicaid
PA390081OtherAARP
PA1007725660003Medicaid
PA60012OtherHORIZON MERCY
PAIY0111OtherBRAVO ELDERHEALTH/HEALTH NET
390081OtherAMERIHEALTH TPA
PA390081OtherTHREE RIVERS NETWORK
PA87726OtherUNITED HEALTHCARE
PA00011OtherHEALTH PARTNERS
PA1493OtherAETNA
PA25152OtherADVANTRA FREEDOM
390081OtherAMERIHEALTH DELCO
NJ4191404Medicaid
PA60012OtherKEYSTONE MERCY HEALTH PLAN
PA62308OtherCIGNA
PAH06015OtherOXFORD
0001493OtherAUSHC
129502OtherMAGELLAN
60012OtherKEYSTONE MERCY HEALTH PLA
PA86033OtherCIGNA MEDICARE ACCESS
PA262730OtherMAMSI
PA390081OtherKINDRED HOSPITAL
PA60012OtherKEYSTONE MERCY HEALTH PLAN