Provider Demographics
NPI:1508971441
Name:MAIN LINE HOSPITALS, INC.
Entity Type:Organization
Organization Name:MAIN LINE HOSPITALS, INC.
Other - Org Name:BRYN MAWR HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUONGIORNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-337-8480
Mailing Address - Street 1:3803 W CHESTER PIKE STE 250
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2336
Mailing Address - Country:US
Mailing Address - Phone:484-337-1814
Mailing Address - Fax:
Practice Address - Street 1:130 S BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3121
Practice Address - Country:US
Practice Address - Phone:610-526-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA280701282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001101000OtherAMERIHEALTH
0001443OtherAETNA
NY00899789Medicaid
60081OtherKEYSTONE MERCY
MD461415100Medicaid
0500157OtherCIGNA
NJ4194705Medicaid
0001101000OtherINDEPENDENCE BLUE CROSS
08307OtherHEALTH PARTNERS
PA100735428Medicaid
258211OtherMAMSI/ALLIANCE PPO
A10014OtherFIRST STATE MA MANAGED C
FL909372900Medicaid
0055726101OtherAMERICHOICE