Provider Demographics
NPI:1679579262
Name:MARIAN COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:MARIAN COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT FINANCIAL SERVI
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-281-1009
Mailing Address - Street 1:100 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-2116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-2116
Practice Address - Country:US
Practice Address - Phone:570-281-1009
Practice Address - Fax:570-281-1029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA450801282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007207OtherFIRST PRIORITY HEALTH
PA14906OtherGEISINGER HOSPITAL CLAIMS
PA56119OtherTHREE RIVERS SPU
PA1007599490021Medicaid
PA1007599490025Medicaid
PA10075994915Medicaid
PA73816OtherTHREE RIVERS ED
PA390095OtherBLUE CROSS HOSPITAL CLAIM
PA68688OtherTHREE RIVERS IP/OP
PA73816OtherTHREE RIVERS ED
PA39S095Medicare ID - Type UnspecifiedMEDICARE PSYC BILLING
PA1007599490025Medicaid