Provider Demographics
NPI:1467424820
Name:SUNBURY HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:SUNBURY HOSPITAL COMPANY LLC
Other - Org Name:SUNBURY COMMUNITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PATIENT FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:P
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-3672
Mailing Address - Street 1:PO BOX 504236
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-4236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 N 11TH ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-1611
Practice Address - Country:US
Practice Address - Phone:570-286-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA450301282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007458540006Medicaid
7390084OtherGATEWAY
039624900OtherBLACK LUNG
PA1007458540005Medicaid
1534OtherBCBS
390084OtherHIGHMARK
22918OtherGHP
240796877OtherAETNA
PA1007458540005Medicaid