Provider Demographics
NPI:1912902206
Name:JEANES HOSPITAL
Entity Type:Organization
Organization Name:JEANES HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-728-3306
Mailing Address - Street 1:7600 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2442
Mailing Address - Country:US
Mailing Address - Phone:215-728-3306
Mailing Address - Fax:215-728-3322
Practice Address - Street 1:7600 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2442
Practice Address - Country:US
Practice Address - Phone:215-728-3306
Practice Address - Fax:215-728-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101301282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1005061110008Medicaid
PA0001015000OtherBLUE CROSS PROVIDER #
PA1468OtherAETNA HMO
PA1468OtherAETNA HMO
PA=========OtherTAX ID