Provider Demographics
NPI:1598829210
Name:DLP CONEMAUGH MINERS MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:DLP CONEMAUGH MINERS MEDICAL CENTER LLC
Other - Org Name:CONEMAUGH MINERS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4536
Mailing Address - Country:US
Mailing Address - Phone:615-920-7000
Mailing Address - Fax:615-920-8913
Practice Address - Street 1:290 HAIDA AVENUE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:PA
Practice Address - Zip Code:16646
Practice Address - Country:US
Practice Address - Phone:814-247-3100
Practice Address - Fax:814-247-3127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10850100261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0134OtherCLUE CROSS (SWING BED)
PA1007506020008Medicaid
PA0079OtherBLUE CROSS (ACUTE)
PA1007506020020Medicaid
PA0079OtherBLUE CROSS (ACUTE)
PA0134OtherCLUE CROSS (SWING BED)