Provider Demographics
NPI:1467887331
Name:EAGLEVILLE HOSPITAL
Entity Type:Organization
Organization Name:EAGLEVILLE HOSPITAL
Other - Org Name:EAGLEVILLE HOSPITAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGLONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-291-2210
Mailing Address - Street 1:100 EAGLEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1829
Mailing Address - Country:US
Mailing Address - Phone:610-635-7426
Mailing Address - Fax:
Practice Address - Street 1:100 EAGLEVILLE RD
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-1829
Practice Address - Country:US
Practice Address - Phone:610-635-7426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4823843336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007779290007Medicaid
2142102OtherPK