Provider Demographics
NPI:1679533079
Name:MEYERSDALE COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:MEYERSDALE COMMUNITY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LIBENGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:814-634-5911
Mailing Address - Street 1:551 MAIN ST
Mailing Address - Street 2:THE INFORMEDX GROUP 3RD FLOOR
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901
Mailing Address - Country:US
Mailing Address - Phone:814-539-5724
Mailing Address - Fax:814-536-7092
Practice Address - Street 1:200 HOSPITAL DR
Practice Address - Street 2:MEYERSDALE EMERGENCY PHYSICIANS GROUP
Practice Address - City:MEYERSDALE
Practice Address - State:PA
Practice Address - Zip Code:15552
Practice Address - Country:US
Practice Address - Phone:814-634-5911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007705070012Medicaid