# INDIANA REGIONAL MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770614919
- **Authorized official:** MR. MICHAEL F ICKOWSKI CPA, MBA (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (724) 357-7008

## Contact information

- **Practice address:** 835 HOSPITAL ROAD, PEDIATRIC & ADOLESCENT DENTAL CLINIC, INDIANA, PA 15701-0788
- **Practice address phone:** (724) 357-6960
- **Practice address fax:** (724) 357-6961
- **Mailing address:** 835 HOSPITAL ROAD, PO BOX 788, INDIANA, PA 15701-0788
- **Mailing address phone:** (724) 357-7009

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 090701 | PA | Yes |

## Other

- **Enumeration date:** 03/08/2007
- **Last updated:** 07/10/2024