Provider Demographics
NPI:1689708570
Name:MONONGAHELA VALLEY HOSPITAL INC
Entity Type:Organization
Organization Name:MONONGAHELA VALLEY HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSNOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-258-1160
Mailing Address - Street 1:1163 COUNTRY CLUB ROAD
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-1095
Mailing Address - Country:US
Mailing Address - Phone:724-258-1000
Mailing Address - Fax:724-258-1394
Practice Address - Street 1:1163 COUNTRY CLUB ROAD
Practice Address - Street 2:
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-1095
Practice Address - Country:US
Practice Address - Phone:724-258-1000
Practice Address - Fax:724-258-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACD4650OtherPALMETTO GBA