Basic Information
| Provider Information | |||||||||
| NPI: | 1518114925 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONEMAUGH DIABETES INSTITUTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 MAIN ST | ||||||||
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| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159011601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145346800 | ||||||||
| FaxNumber: | 8145346937 | ||||||||
| Practice Location | |||||||||
| Address1: | 1086 FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159054305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145349000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2008 | ||||||||
| LastUpdateDate: | 08/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | DEPASQUALE | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8144108271 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CONEMAUGH VALLEY MEMORIAL HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | 1659376358 | PA | N | Hospitals | General Acute Care Hospital | Rural | 282NR1301X | 1184620486 | PA | N | Hospitals | General Acute Care Hospital | Rural | 282NR1301X | 1801897038 | PA | Y | Hospitals | General Acute Care Hospital | Rural |
No ID Information.