Provider Demographics
NPI:1790765477
Name:JAMESON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:JAMESON MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:AUBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-656-4008
Mailing Address - Street 1:1211 WILMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-2516
Mailing Address - Country:US
Mailing Address - Phone:724-656-4100
Mailing Address - Fax:724-656-4161
Practice Address - Street 1:1211 WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-2516
Practice Address - Country:US
Practice Address - Phone:724-656-4100
Practice Address - Fax:724-656-4161
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPMC JAMESON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-19
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAHP418097L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000021890020Medicaid
PA1000021890021Medicaid
PA1000021890011Medicaid
PA1000021890018Medicaid
PA1000021890007Medicaid
PA1000021890020Medicaid
PA39-S016Medicare Oscar/Certification
PA39-0016Medicare Oscar/Certification
PA1477538312Medicare Oscar/Certification
PA1447236005Medicare Oscar/Certification
PA39-6049Medicare ID - Type UnspecifiedJAMESON CARE CENTER
PA1000021890021Medicaid
PA39-T016Medicare Oscar/Certification
PA1144205097Medicare ID - Type UnspecifiedHOME HEALTH CARE DIVISION
PA1000021890007Medicaid
PA1255317822Medicare Oscar/Certification
PA1447236005Medicare ID - Type UnspecifiedJAMESON TRANSITIONAL CARE
PA1000021890011Medicaid
PA1780669531Medicare ID - Type UnspecifiedJAMESON CARE CENTER
PA1000021890018Medicaid