Provider Demographics
NPI:1376543942
Name:WINDBER HOSPITAL, INC.
Entity Type:Organization
Organization Name:WINDBER HOSPITAL, INC.
Other - Org Name:WINDBERCARE SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:KURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-467-3702
Mailing Address - Street 1:600 SOMERSET AVE
Mailing Address - Street 2:
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963-1331
Mailing Address - Country:US
Mailing Address - Phone:814-467-3653
Mailing Address - Fax:814-467-3655
Practice Address - Street 1:600 SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-1331
Practice Address - Country:US
Practice Address - Phone:814-467-3653
Practice Address - Fax:814-467-3655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINDBER HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-26
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208600000X
PAMD029007E208600000X
PAMD059296L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007703740030Medicaid
PA1634084OtherBLUE CROSS
PA1634084OtherBLUE CROSS