Provider Demographics
NPI:1710087069
Name:ELLWOOD MEDICAL CENTER OPERATIONS, LLC
Entity Type:Organization
Organization Name:ELLWOOD MEDICAL CENTER OPERATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNARUMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-752-6750
Mailing Address - Street 1:724 PERSHING ST
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-1474
Mailing Address - Country:US
Mailing Address - Phone:724-752-0081
Mailing Address - Fax:724-752-0966
Practice Address - Street 1:724 PERSHING ST
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-1474
Practice Address - Country:US
Practice Address - Phone:724-752-0081
Practice Address - Fax:724-752-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2017-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA050501282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100771854-0005Medicaid
PA100771854-0006Medicaid
PA0076OtherHIGHMARK BLUE CROSS
PA100771854-0012Medicaid
PA100771854-0012Medicaid