# JERSEY SHORE HOSPITAL FOUNDATION, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jersey Shore Medical Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417019498
- **Authorized official:** MR. CAREY W. PLUMMER CEO (CEO)
- **Authorized official phone:** (570) 398-3101

## Contact information

- **Practice address:** 104 EAST CENTRAL AVENUE, AVIS, PA 17721
- **Practice address phone:** (570) 753-8620
- **Practice address fax:** (570) 753-5489
- **Mailing address:** 104 EAST CENTRAL AVENUE, PO BOX 430, AVIS, PA 17721
- **Mailing address phone:** (570) 753-8620
- **Mailing address fax:** (570) 753-5489

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 12/15/2006
- **Last updated:** 04/03/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1001557500008 | — | PA |
| 01 | — | 220807 | FIRST PRIORITY HEALTH | PA |
| 01 | — | 555630 | BLUE CROSS BLUE SHIELD | PA |
| 01 | — | 5938 | AETNA | PA |
| 01 | — | C2CE | GEISINGER HEALTH PLAN | PA |
| 01 | — | CL3010 | RAILROAD MEDICARE | PA |