Provider Demographics
NPI:1366488108
Name:JEFFERSON REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:JEFFERSON REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-267-6095
Mailing Address - Street 1:565 COAL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3703
Mailing Address - Country:US
Mailing Address - Phone:412-267-6050
Mailing Address - Fax:412-267-6472
Practice Address - Street 1:565 COAL VALLEY RD
Practice Address - Street 2:
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3703
Practice Address - Country:US
Practice Address - Phone:412-267-6050
Practice Address - Fax:412-267-6472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA711801282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007443470018Medicaid
PA0085OtherHIGHMARK
PA1007443470018Medicaid