Provider Demographics
NPI:1326236654
Name:THE CARBON SCHUYLKILL COMMUNITY HOSPITAL INC
Entity Type:Organization
Organization Name:THE CARBON SCHUYLKILL COMMUNITY HOSPITAL INC
Other - Org Name:ST. LUKE'S MINER'S HEALTH CENTER-NESQUEHONING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:S.V.P. FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:LICHTENWALNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-954-3301
Mailing Address - Street 1:108 W. CATAWISSA ST.
Mailing Address - Street 2:
Mailing Address - City:NESQUEHONING
Mailing Address - State:PA
Mailing Address - Zip Code:18240-1511
Mailing Address - Country:US
Mailing Address - Phone:570-669-9990
Mailing Address - Fax:570-669-9785
Practice Address - Street 1:108 W. CATAWISSA ST.
Practice Address - Street 2:
Practice Address - City:NESQUEHONING
Practice Address - State:PA
Practice Address - Zip Code:18240-1511
Practice Address - Country:US
Practice Address - Phone:570-669-9990
Practice Address - Fax:570-669-9285
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CARBON SCHUYLKILL COMMUNITY HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA178775Medicare PIN