Provider Demographics
NPI:1689080657
Name:DLP CONEMAUGH PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:DLP CONEMAUGH PHYSICIAN PRACTICES LLC
Other - Org Name:CHI BERKLEY HILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:N
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:1 TECH PARK DR
Mailing Address - Street 2:STE. 1130
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-2515
Mailing Address - Country:US
Mailing Address - Phone:814-475-8700
Mailing Address - Fax:814-475-8795
Practice Address - Street 1:1 TECH PARK DR
Practice Address - Street 2:STE. 1130
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-2515
Practice Address - Country:US
Practice Address - Phone:814-475-8700
Practice Address - Fax:814-475-8795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty