Provider Demographics
NPI:1801889969
Name:INDIANA REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:INDIANA REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:ICKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, MBA
Authorized Official - Phone:724-357-7008
Mailing Address - Street 1:835 HOSPITAL RD
Mailing Address - Street 2:PO BOX 788
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3629
Mailing Address - Country:US
Mailing Address - Phone:724-357-7008
Mailing Address - Fax:724-357-7414
Practice Address - Street 1:145 IRMC DR
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3673
Practice Address - Country:US
Practice Address - Phone:724-357-7404
Practice Address - Fax:724-357-7414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001354OtherHIGHMARK
PA1007713530013Medicaid
PA001354OtherHIGHMARK