Organization
INDIANA REGIONAL MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL F ICKOWSKI CPA, MBA (CHIEF FINANCIAL OFFICER)
(724) 357-7008
Entity
Organization
Contact information
Practice address
1265 WAYNE AVE BLDG SUITE201, CENTER FOR WOUND HEALING, INDIANA, PA 15701-3501
(724) 357-7008
(724) 357-7414
Mailing address
PO BOX 788, 835 HOSPITAL ROAD, INDIANA, PA 15701-0788
(724) 357-7008
(724) 357-7414
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
282NR1301X
Rural Acute Care Hospital
Primary
090701
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000068
HIGHMARK
PA
05
—
1007713530032
—
PA
Enumeration date
11/16/2007
Last updated
07/10/2024
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