Provider Demographics
NPI:1376590711
Name:ST. JOSEPH REGIONAL HEALTH NETWORK
Entity Type:Organization
Organization Name:ST. JOSEPH REGIONAL HEALTH NETWORK
Other - Org Name:ST. JOSEPH HEALTH NETWORK AT ELVERSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHABALOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-378-2300
Mailing Address - Street 1:45 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:ELVERSON
Mailing Address - State:PA
Mailing Address - Zip Code:19520-9720
Mailing Address - Country:US
Mailing Address - Phone:610-913-1234
Mailing Address - Fax:717-531-0690
Practice Address - Street 1:45 S PINE ST
Practice Address - Street 2:
Practice Address - City:ELVERSON
Practice Address - State:PA
Practice Address - Zip Code:19520-9720
Practice Address - Country:US
Practice Address - Phone:610-913-1234
Practice Address - Fax:717-531-0690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ST1739907OtherHIGHMARK
99129OtherAETNA
50050696OtherCAPITAL BC
092628Medicare ID - Type Unspecified