Provider Demographics
NPI:1396769782
Name:WVHCS-HOSPITAL
Entity type:Organization
Organization Name:WVHCS-HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-552-3023
Mailing Address - Street 1:575 N RIVER ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18764-0999
Mailing Address - Country:US
Mailing Address - Phone:570-829-8111
Mailing Address - Fax:570-552-3030
Practice Address - Street 1:575 N RIVER ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18764-0999
Practice Address - Country:US
Practice Address - Phone:570-829-8111
Practice Address - Fax:570-552-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA234501282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0299OtherFREEDOM BLUE
PA1024614OtherKEYSTONE MERCY
PA1024614OtherAMERIHEALTH
PA68767OtherUNISON MANAGED CARE
PA1008143800001Medicaid
PA56307OtherUNISON MANAGED CARE
PA390137OtherBLUE CROSS
PA080570OtherFIRST PRIORITY HEALTH
PA1008143800008Medicaid
PA390137OtherSTERLING
PA6491500OtherAETNA
PA68767OtherUNISON ADVANTAGE
PAIY0034OtherHEALTHNET
PA68767OtherUNISON MANAGED CARE
PA1008143800001Medicaid