Provider Demographics
NPI:1245335629
Name:MAIN LINE HOSPITALS, INC.
Entity type:Organization
Organization Name:MAIN LINE HOSPITALS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUONGIORNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-526-8480
Mailing Address - Street 1:240 N RADNOR CHESTER RD
Mailing Address - Street 2:
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5170
Mailing Address - Country:US
Mailing Address - Phone:484-337-1814
Mailing Address - Fax:
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-645-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA120401282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001019000OtherAMERIHEALTH
FL912945600Medicaid
NY00431470Medicaid
PA1007354280039Medicaid
0001019000OtherINDEPENDENCE BLUE CROSS
NJ4197909Medicaid
60024OtherKEYSTONE MERCY
0001427OtherAETNA
DE000607205Medicaid
0071399204OtherAMERICHOICE
PA1007766910Medicaid
WA3025459Medicaid
GA668399483AMedicaid
258210OtherMAMSI/ALLIANCE