Provider Demographics
NPI:1760464457
Name:PHC-ASHLAND, L.P.
Entity Type:Organization
Organization Name:PHC-ASHLAND, L.P.
Other - Org Name:ASHLAND REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRACEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:101 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17921-2147
Mailing Address - Country:US
Mailing Address - Phone:570-875-5979
Mailing Address - Fax:570-875-5980
Practice Address - Street 1:101 BROAD ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:PA
Practice Address - Zip Code:17921-2147
Practice Address - Country:US
Practice Address - Phone:570-875-5979
Practice Address - Fax:570-875-5980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA270401282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIOP39018Medicaid
PA390181OtherCAPITAL BLUE CROSS
PA212336OtherBLACK LUNG
053176P76Medicare ID - Type UnspecifiedHOSPITAL PART B
PA212336OtherBLACK LUNG