Basic Information
| Provider Information | |||||||||
| NPI: | 1881690212 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PENN STATE HEALTH HOLY SPIRIT MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 503 N 21ST ST | ||||||||
| Address2: | |||||||||
| City: | CAMP HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170112204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177632141 | ||||||||
| FaxNumber: | 7177632932 | ||||||||
| Practice Location | |||||||||
| Address1: | 503 N 21ST ST | ||||||||
| Address2: | |||||||||
| City: | CAMP HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170112204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177632141 | ||||||||
| FaxNumber: | 7177632932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2005 | ||||||||
| LastUpdateDate: | 03/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | MCKENNA | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7175310003 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 03/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 251E00000X | PA | N | Agencies | Home Health | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 273R00000X | 340801 | PA | N | Hospital Units | Psychiatric Unit | 282N00000X | 340801 | PA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1007718810099 | 05 | PA | MEDICAID | 1007718810056 | 05 | PA | MEDICAID | 1007718810076 | 05 | PA | MEDICAID | 1007718810102 | 05 | PA | MEDICAID | 1007718810104 | 05 | PA | MEDICAID | 1007718810081 | 05 | PA | MEDICAID |