Provider Demographics
NPI:1679637482
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:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7220
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:814-247-3119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10850100275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0134OtherBLUE CROSS (SWING BED)
PA1007506020008Medicaid
PA0079OtherBLUE CROSS (ACUTE)
PA1007506020020Medicaid
PA1007506020008Medicaid
PA39U130Medicare Oscar/Certification