Provider Demographics
NPI:1912905548
Name:MONONGAHELA VALLEY HOSPITAL, INC.
Entity Type:Organization
Organization Name:MONONGAHELA VALLEY HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSNOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-258-1160
Mailing Address - Street 1:1163 COUNTRY CLUB ROAD
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-1095
Mailing Address - Country:US
Mailing Address - Phone:724-258-1160
Mailing Address - Fax:724-258-1394
Practice Address - Street 1:1163 COUNTRY CLUB ROAD
Practice Address - Street 2:
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-1095
Practice Address - Country:US
Practice Address - Phone:724-258-1160
Practice Address - Fax:724-258-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA137001282N00000X
282N00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0171067000OtherUNISYS
NY00744078OtherMEDICAID NEW YORK
PA1000215OtherGATEWAY HEALTH PLAN
PA100738887 0003Medicaid
PA103545OtherUPMC
PA1477477OtherUNITED MINE WORKERS
NC3900147OtherMEDICAID NORTH CAROLINA
PA0009520OtherAETNA
PA142408OtherHEALTH AMERICA HEALTH ASSURANCE
OH0284437OtherMEDICAID OHIO
PA100738887 0001Medicaid
PA100738887 0006Medicaid
PA390147OtherMEDICARE ID-LEGACY
PA961OtherHIGHMARK BLUE CROSS-REHAB
PA0728500OtherUNITED MINE WORKERS
PA100738887 0002Medicaid
PA100738887 0011Medicaid
CA6466926OtherMEDICAID CALIFORNIA -OP
PAA139133OtherMULTI PLAN
PA0004405OtherUNITED MINE WORKERS
PA092OtherHIGHMARK BLUE CROSS
AL142852OtherMEDICAID ARIZONA
CA5486926OtherMEDICAID CALIFORNIA IP
PA56053OtherUNISON
PA918OtherHIGHMARK BLUE CROSS- PSYC