Provider Demographics
NPI:1336166974
Name:LATROBE AREA HOSPITAL, INC.
Entity Type:Organization
Organization Name:LATROBE AREA HOSPITAL, INC.
Other - Org Name:LATROBE FAMILY MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT/EXEC DIR - EHPP
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DISHONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-830-8500
Mailing Address - Street 1:134 INDUSTRIAL PARK RD
Mailing Address - Street 2:STE 2300A
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-7328
Mailing Address - Country:US
Mailing Address - Phone:724-689-1835
Mailing Address - Fax:724-850-8096
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:724-537-1480
Practice Address - Fax:724-539-6353
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LATROBE AREA HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-17
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100761052Medicaid
PA664131OtherHIGHMARK
PA664131OtherHIGHMARK