Provider Demographics
NPI:1710007596
Name:CANONSBURG GENERAL HOSPITAL - SPU
Entity Type:Organization
Organization Name:CANONSBURG GENERAL HOSPITAL - SPU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALINKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-873-5892
Mailing Address - Street 1:100 MEDICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-9762
Mailing Address - Country:US
Mailing Address - Phone:724-745-6100
Mailing Address - Fax:724-873-1116
Practice Address - Street 1:100 MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-9762
Practice Address - Country:US
Practice Address - Phone:724-745-6100
Practice Address - Fax:724-873-1116
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANONSBURG GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-29
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA29530100261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100727730003Medicaid