Provider Demographics
NPI:1265498299
Name:LEHIGH VALLEY HOSPITAL - SCHUYLKILL
Entity Type:Organization
Organization Name:LEHIGH VALLEY HOSPITAL - SCHUYLKILL
Other - Org Name:SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:REPPY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-621-4003
Mailing Address - Street 1:502 S 2ND ST., SUITE A
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:PA
Mailing Address - Zip Code:17970-1362
Mailing Address - Country:US
Mailing Address - Phone:570-622-5898
Mailing Address - Fax:570-621-4215
Practice Address - Street 1:502 S 2ND ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:PA
Practice Address - Zip Code:17970-1362
Practice Address - Country:US
Practice Address - Phone:570-622-5898
Practice Address - Fax:570-621-4215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA541024276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1508OtherBLUE SHIELD OF PA
PA1122155OtherCIGNA BEHAVIORAL HEALTH
PA320758OtherVALUE OPTIONS
PA1007604490004Medicaid
PA39A031OtherBLUE CROSS OF PA