Basic Information
| Provider Information | |||||||||
| NPI: | 1902804552 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE CHAMBERSBURG HOSPITAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | WELLSPAN CHAMBERSBURG HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7177096549 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172673000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2005 | ||||||||
| LastUpdateDate: | 09/27/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BUCZKOWSKI | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SR VP AND CFO | ||||||||
| AuthorizedOfficialTelephone: | 4104423373 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 036001 | PA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 614548 | 01 | PA | FIRST HEALTH NETWORK | OTHER | 58993401 | 01 | PA | CAREFIRST BLUE CROSS | OTHER | 337170 | 01 | PA | OPTIMUM CHOICE | OTHER | 1007459700009 | 05 | PA | MEDICAID | 1010748 | 01 | PA | GATEWAY | OTHER | 20008036 | 01 | PA | AMERIHEALTH MERCY | OTHER | 337170 | 01 | PA | ALLIANCE | OTHER | 06285500 | 05 | MD | MEDICAID | 1485 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 390151 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 000000056853 | 01 | PA | UNISON SAME DAY SURG | OTHER | 337170 | 01 | PA | MAMSI | OTHER | 6490260 | 01 | PA | AETNA | OTHER | 000000065233 | 01 | PA | THREE RIVERS/MED PLUS | OTHER | 2196 | 01 | PA | HEALTH AMERICA | OTHER |