Provider Demographics
NPI:1659780039
Name:MEADVILLE MEDICAL CENTER
Entity Type:Organization
Organization Name:MEADVILLE MEDICAL CENTER
Other - Org Name:MEADVILLE WORKPLACE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RENATO
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUNTAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-333-5007
Mailing Address - Street 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-333-5503
Mailing Address - Fax:814-333-5925
Practice Address - Street 1:11277 VERNON PL STE 101
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3718
Practice Address - Country:US
Practice Address - Phone:814-333-5503
Practice Address - Fax:814-333-5925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-11
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100752115-0097Medicaid
PA378240Medicare PIN