Provider Demographics
NPI:1447425368
Name:GNADEN HUETTEN MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:GNADEN HUETTEN MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDRAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-377-7003
Mailing Address - Street 1:43 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-1943
Mailing Address - Country:US
Mailing Address - Phone:610-377-1300
Mailing Address - Fax:
Practice Address - Street 1:43 W BROAD ST
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-1943
Practice Address - Country:US
Practice Address - Phone:610-377-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA070501261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1004958310041Medicaid