Provider Demographics
NPI:1124076039
Name:EVANGELICAL COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:EVANGELICAL COMMUNITY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:AUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-522-2501
Mailing Address - Street 1:ONE HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9350
Mailing Address - Country:US
Mailing Address - Phone:570-522-2000
Mailing Address - Fax:570-768-3904
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9314
Practice Address - Country:US
Practice Address - Phone:570-522-2000
Practice Address - Fax:570-522-2069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA570201282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007731510021Medicaid
PA8769OtherHEALTH AMERICA
PA390013OtherCAPITAL BLUE CROSS
PA1007731510008Medicaid
PA1513OtherHIGHMARK
PA12800OtherGHP
PA390013Medicare ID - Type Unspecified