Provider Demographics
NPI:1750488995
Name:PALMERTON HOSPITAL
Entity Type:Organization
Organization Name:PALMERTON HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDRAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-377-7003
Mailing Address - Street 1:135 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-1518
Mailing Address - Country:US
Mailing Address - Phone:610-826-3141
Mailing Address - Fax:610-377-7176
Practice Address - Street 1:135 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-1518
Practice Address - Country:US
Practice Address - Phone:610-826-3141
Practice Address - Fax:610-377-7176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA420601261QR0400X, 282N00000X
PA920080273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA074000OtherFIRST PRIORITY HEALTH
PA60623OtherAMERIHEALTH MERCY
PA76928OtherUNISON HEALTH PLAN
PA1007743190009Medicaid
PA1504385OtherGATEWAY HEALTH PLAN
PA1007743190008Medicaid
PA390019OtherBLUE CROSS
PA6490810OtherAENTA USHC
PA1007743190009Medicaid
PA770738Medicare Oscar/Certification
PA390019Medicare Oscar/Certification