Provider Demographics
NPI:1457350548
Name:LEHIGH VALLEY HOSPITAL - SCHUYLKILL
Entity Type:Organization
Organization Name:LEHIGH VALLEY HOSPITAL - SCHUYLKILL
Other - Org Name:THE POTTSVILLE HOSPITAL AND WARNE CLINIC (HOME HEALTH)
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EVP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHOZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-862-3943
Mailing Address - Street 1:420 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3625
Mailing Address - Country:US
Mailing Address - Phone:570-621-5000
Mailing Address - Fax:570-622-8221
Practice Address - Street 1:420 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3625
Practice Address - Country:US
Practice Address - Phone:570-621-5000
Practice Address - Fax:570-622-8221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA421001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100760725-0010Medicaid
PA1499OtherHIGHMARK/BLUE SHIELD
PA39-7214OtherCAPITAL BLUE CROSS
PA100760725-0010Medicaid