Provider Demographics
NPI:1588606339
Name:MAMMOGRAM SCREENINGS WARREN GEN HOSP
Entity Type:Organization
Organization Name:MAMMOGRAM SCREENINGS WARREN GEN HOSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC DIR FISCAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JULE
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-723-3300
Mailing Address - Street 1:2 W CRESCENT PARK
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2111
Mailing Address - Country:US
Mailing Address - Phone:814-723-4973
Mailing Address - Fax:814-723-8515
Practice Address - Street 1:2 W CRESCENT PARK
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2111
Practice Address - Country:US
Practice Address - Phone:814-723-4973
Practice Address - Fax:814-723-8515
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WARREN GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-12
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4904012471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA754792OtherHIGHMARK
PA754792Medicare ID - Type Unspecified