Provider Demographics
NPI:1114962842
Name:POST ACUTE MEDICAL AT LULING LLC
Entity Type:Organization
Organization Name:POST ACUTE MEDICAL AT LULING LLC
Other - Org Name:PAM SPECIALTY HOSPITAL OF LULING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:F
Authorized Official - Last Name:MISITANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-731-9660
Mailing Address - Street 1:1828 GOOD HOPE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1233
Mailing Address - Country:US
Mailing Address - Phone:717-731-9660
Mailing Address - Fax:
Practice Address - Street 1:200 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:TX
Practice Address - Zip Code:78648-3213
Practice Address - Country:US
Practice Address - Phone:830-875-8400
Practice Address - Fax:830-875-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X, 273Y00000X, 275N00000X, 282E00000X, 283X00000X
TX000184284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No273Y00000XHospital UnitsRehabilitation Unit
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282E00000XHospitalsLong Term Care Hospital
No283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1127409-01Medicaid
TX1430266-01Medicaid
TX1991911-01Medicaid
TX1991911-01Medicaid