Basic Information
| Provider Information | |||||||||
| NPI: | 1194848960 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JC BLAIR MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1225 WARM SPRINGS AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGDON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166522350 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1225 WARM SPRINGS AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGDON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166522350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8146432290 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 02/23/2016 | ||||||||
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| AuthorizedOfficialLastName: | HAWKINS | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8146438838 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | JC BLAIR MEMORIAL HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 101101 | PA | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 1007683760040 | 05 | PA | MEDICAID |