Provider Demographics
NPI:1497836274
Name:VILLA ST JOHN VIANNEY
Entity Type:Organization
Organization Name:VILLA ST JOHN VIANNEY
Other - Org Name:ST JOHN VIANNEY HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CZEKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-368-0900
Mailing Address - Street 1:151 WOODBINE ROAD
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335
Mailing Address - Country:US
Mailing Address - Phone:610-269-2600
Mailing Address - Fax:610-873-8028
Practice Address - Street 1:151 WOODBINE ROAD
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335
Practice Address - Country:US
Practice Address - Phone:610-269-2600
Practice Address - Fax:610-873-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA124630283Q00000X
PA023898291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001057000OtherINDEPENDENCE BLUE CROSS