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
835 HOSPITAL ROAD, PEDIATRIC & ADOLESCENT DENTAL CLINIC, INDIANA, PA 15701-0788
(724) 357-6960
(724) 357-6961
Mailing address
835 HOSPITAL ROAD, PO BOX 788, INDIANA, PA 15701-0788
(724) 357-7009
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
090701
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100771353 0003
—
PA
Enumeration date
03/08/2007
Last updated
07/10/2024
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