Provider Demographics
NPI:1093794810
Name:MID VALLEY HOSPITAL ASSOC
Entity Type:Organization
Organization Name:MID VALLEY HOSPITAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINES MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOOMEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-340-2983
Mailing Address - Street 1:PO BOX 1489
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18501-1489
Mailing Address - Country:US
Mailing Address - Phone:570-340-2983
Mailing Address - Fax:570-340-2243
Practice Address - Street 1:1400 MAIN ST
Practice Address - Street 2:
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2009
Practice Address - Country:US
Practice Address - Phone:570-340-2983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID VALLEY HOSPITAL ASSOC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-11
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390501282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007733330Medicaid
PA1007733330Medicaid