Provider Demographics
NPI:1942396163
Name:INDIANA REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:INDIANA REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VICE PRESIDENT, FINANCE
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 1:835 HOSPITAL ROAD
Mailing Address - Street 2:PO BOX 788
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-0788
Mailing Address - Country:US
Mailing Address - Phone:724-357-7008
Mailing Address - Fax:
Practice Address - Street 1:835 HOSPITAL ROAD
Practice Address - Street 2:PET SCAN
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-0788
Practice Address - Country:US
Practice Address - Phone:724-357-7008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA090701282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00068OtherHIGHMARK
PA1007713530001Medicaid
PA00068OtherHIGHMARK