Organization
JERSEY SHORE HOSPITAL
Active
Other names
JSECPA
Organization subpart
No
Provider details
NPI number
Authorized official
MARK A. O'NEILL (CFO)
(570) 398-3100
Entity
Organization
Contact information
Practice address
1020 THOMPSON ST, JERSEY SHORE, PA 17740-1729
(570) 398-0100
(570) 398-4412
Mailing address
1020 THOMPSON ST, JERSEY SHORE, PA 17740-1729
(570) 398-0100
(570) 398-4412
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
101401
PA
207P00000X
Emergency Medicine Physician
Primary
101401
PA
2085R0202X
Diagnostic Radiology Physician
101401
PA
282NC0060X
Critical Access Hospital
101401
PA
363AS0400X
Surgical Physician Assistant
101401
PA
367500000X
Certified Registered Nurse Anesthetist
101401
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007703560004
—
PA
01
—
116482
HA ER
PA
01
—
139690
HA ANESTHSIA
PA
01
—
222069
ER FPH
PA
01
—
222070
RADIOLOGY FPH
PA
01
—
230275
HA RADIOLOGY
PA
01
—
3634
GHP
PA
01
—
391300
WORKERS COMP
PA
01
—
C10719
RR MEDICARE DR GROUP
PA
Enumeration date
02/14/2007
Last updated
10/27/2007
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