Provider Demographics
NPI:1225439821
Name:PAM SQUARED AT TEXARKANA, LLC
Entity Type:Organization
Organization Name:PAM SQUARED AT TEXARKANA, LLC
Other - Org Name:PAM SPECIALTY HOSPITAL OF TEXARKANA NORTH
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:717-731-9665
Practice Address - Street 1:2400 SAINT MICHAEL DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2374
Practice Address - Country:US
Practice Address - Phone:903-614-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR208169105Medicaid
TX346138602Medicaid
TX346138601Medicaid
OK200645170 AMedicaid
AR208169105Medicaid