Basic Information
| Provider Information | |||||||||
| NPI: | 1801897038 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DLP CONEMAUGH MEMORIAL MEDICAL CENTER LLC | ||||||||
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| OtherOrganizationName: | MEMORIAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 SEVEN SPRINGS WAY | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370274536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159207000 | ||||||||
| FaxNumber: | 6159208913 | ||||||||
| Practice Location | |||||||||
| Address1: | 1086 FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159054305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145349000 | ||||||||
| FaxNumber: | 8145390264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 04/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | DILLON | ||||||||
| AuthorizedOfficialFirstName: | TERRANCE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSISTANT SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 5025967220 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 035601 | PA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 30014300 | 01 | PA | FEDERAL BLACK LUNG PROGRA | OTHER | 250965307 | 01 | PA | COMMERCIAL GENERAL HOSPIT | OTHER | 0033 | 01 | PA | BLUE CROSS GENERAL HOSP | OTHER | 1004907 | 01 | PA | GATEWAY GENERAL HOSP | OTHER | 103577 | 01 | PA | UPMC GENERAL HOSPITAL | OTHER | 60573 | 01 | PA | UNISON GENRAL HOSPITAL | OTHER | 1007568490052 | 05 | PA | MEDICAID | 119651801 | 01 | PA | FEDERAL WORKERS COMPENSAT | OTHER |