Provider Demographics
NPI:1245353846
Name:LATROBE AREA HOSPITAL
Entity type:Organization
Organization Name:LATROBE AREA HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATANIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-832-4660
Mailing Address - Street 1:1 MELLON WAY
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1197
Mailing Address - Country:US
Mailing Address - Phone:724-537-1256
Mailing Address - Fax:724-537-1265
Practice Address - Street 1:1 MELLON WAY
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1197
Practice Address - Country:US
Practice Address - Phone:724-537-1256
Practice Address - Fax:724-537-1265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAHP418107L3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100761052Medicaid
2084843OtherPK