Provider Demographics
NPI:1346519386
Name:PECKVILLE HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:PECKVILLE HOSPITAL COMPANY LLC
Other - Org Name:MID-VALLEY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTH OFFICIAL / DIR BO SUP
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:1400 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-2009
Mailing Address - Country:US
Mailing Address - Phone:570-340-2983
Mailing Address - Fax:
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:PECKVILLE HOSPITAL COMPANY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-20
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
39Z311Medicare Oscar/Certification