Provider Demographics
NPI:1881690212
Name:PENN STATE HEALTH HOLY SPIRIT MEDICAL CENTER
Entity Type:Organization
Organization Name:PENN STATE HEALTH HOLY SPIRIT MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, INTERIM
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-763-2100
Mailing Address - Street 1:503 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2204
Mailing Address - Country:US
Mailing Address - Phone:717-763-2100
Mailing Address - Fax:
Practice Address - Street 1:503 N 21ST ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2204
Practice Address - Country:US
Practice Address - Phone:717-763-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 261Q00000X
PA251E00000X
PA340801273R00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007718810102Medicaid
PA1007718810104Medicaid
PA1007718810081Medicaid
PA1007718810056Medicaid
PA1007718810076Medicaid
PA1007718810099Medicaid
PACA3668Medicare PIN
PA101615Medicare PIN
PA400688Medicare PIN
PA397250BMedicare Oscar/Certification
PA1007623900006Medicaid
PA1007718810076Medicaid
PA1007718810081Medicaid
PACA3672Medicare PIN
PA112517Medicare PIN
PA390004Medicare Oscar/Certification