Provider Demographics
NPI:1821198755
Name:GEISINGER BLOOMSBURG HOSPITAL
Entity Type:Organization
Organization Name:GEISINGER BLOOMSBURG HOSPITAL
Other - Org Name:THE BLOOMSBURG HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SYSTEM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-271-6603
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6211
Mailing Address - Fax:
Practice Address - Street 1:549 FAIR ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1419
Practice Address - Country:US
Practice Address - Phone:570-387-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 282NC0060X, 282NC2000X, 282NR1301X, 282NW0100X, 286500000X, 2865M2000X
PA025001282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282NC2000XHospitalsGeneral Acute Care HospitalChildren
No282NR1301XHospitalsGeneral Acute Care HospitalRural
No282NW0100XHospitalsGeneral Acute Care HospitalWomen
No286500000XHospitalsMilitary Hospital
No2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007740410009Medicaid
PA390003Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER