Provider Demographics
NPI:1891099636
Name:INDIANA REGIONAL MEDICAL CENTER - CRNA-IASA
Entity Type:Organization
Organization Name:INDIANA REGIONAL MEDICAL CENTER - CRNA-IASA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONGAWARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-357-7008
Mailing Address - Street 1:1699 WASHINGTON RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-1629
Mailing Address - Country:US
Mailing Address - Phone:412-831-3744
Mailing Address - Fax:412-831-5663
Practice Address - Street 1:841 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3620
Practice Address - Country:US
Practice Address - Phone:724-465-1922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIANA REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-10
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty