Organization
CONEMAUGH VALLEY MEMORIAL HOSPITAL
Active
Other names
EPSDT
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN A DZIAGWA (DIRECTOR PFS)
(814) 410-8296
Entity
Organization
Contact information
Practice address
1086 FRANKLIN ST, JOHNSTOWN, PA 15905-4305
(814) 534-1821
(814) 534-1743
Mailing address
1086 FRANKLIN ST, JOHNSTOWN, PA 15905
(814) 410-8296
(814) 410-8597
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1004907
GATEWAY EPSDT
PA
05
—
1007568490053
—
PA
Enumeration date
11/01/2006
Last updated
04/23/2008
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