Provider Demographics
NPI:1609984889
Name:WASHINGTON HOSPITAL
Entity Type:Organization
Organization Name:WASHINGTON HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-223-3004
Mailing Address - Street 1:155 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3398
Mailing Address - Country:US
Mailing Address - Phone:724-225-7000
Mailing Address - Fax:724-229-2098
Practice Address - Street 1:155 WILSON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3398
Practice Address - Country:US
Practice Address - Phone:724-225-7000
Practice Address - Fax:724-229-2098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA230201282N00000X
284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100738911-0009Medicaid
PA0019OtherHIGHMARK BC/BS
PA100738911-0008Medicaid
PA100738911-0008Medicaid