Active NPI
Divine Providence Hospital of the Sisters of Christian Charity
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Selinsgrove, PA
National Provider Identifier
1023110459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- License
- 041001
- Legal business name
- DIVINE PROVIDENCE HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY
- Practice address
- 21 Susquehanna Valley Mall Drive
Suite D
Selinsgrove, PA 17870 - Phone
- (570) 374-5454
- Fax
- (570) 326-8601
- NPI assigned
- Sep 5, 2006
- Organization subpart
- Yes
- Parent organization
- DIVINE PROVIDENCE HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Charles J. Santangelo, CPA FHFMA
- Title
- Executive VP Cfo
- Phone
- (570) 321-3171
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | 041001 | PA | Primary |
Addresses
Primary practice location
21 Susquehanna Valley Mall Drive
Suite D
Selinsgrove, PA 17870
Mailing address
1205 Grampian Blvd
2ND Floor
Williamsport, PA 17701-1978
Phone (570) 326-8676
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 393510 | Other | PA | BLUE CROSS PIN |
| 816867 | Other | PA | FIRST PRIORITY HEALTH PIN |
| 394048 | Other | PA | HEALTH AMERICA PIN |
| 70159 | Other | PA | GEISINGER HEALTH PLAN PIN |
| 1007563750011 | Medicaid | PA | |
| 000070 | Other | PA | AMERIHEALTH ADMINSTR PIN |
| 1066310 | Other | PA | KEYSTONE MERCY HEALTH PIN |
| 20012697 | Other | PA | AMERIHEALTH HMO AMER PIN |
| 394048 | Other | PA | AETNA PIN |
| 394048 | Other | PA | HEALTH ASSURANCE PIN |
| 396871 | Other | PA | BLACK LUNG PROGRAM PIN |
Other names 1
- Divine Providence Hospital
National Provider Directory
National Provider Directory- Part of
- Diabetes Center Divine
Locations
32-36 Central Ave
Fl 3
Wellsboro, PA 16901
Phone (570) 723-0760
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- South Williamsport, PA
- NPI 1457314122
-
- Anatomic Pathology & Clinical Pathology Physician
- Williamsport, PA
- NPI 1629181797
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157414400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1208649600000",
"number": "1023110459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1205 GRAMPIAN BLVD",
"address_2": "2ND FLOOR",
"city": "WILLIAMSPORT",
"state": "PA",
"postal_code": "177011978",
"telephone_number": "570-326-8676",
"fax_number": "570-326-8601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 SUSQUEHANNA VALLEY MALL DRIVE",
"address_2": "SUITE D",
"city": "SELINSGROVE",
"state": "PA",
"postal_code": "17870",
"telephone_number": "570-374-5454",
"fax_number": "570-326-8601"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DIVINE PROVIDENCE HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "DIVINE PROVIDENCE HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY",
"enumeration_date": "2006-09-05",
"last_updated": "2008-04-20",
"status": "A",
"authorized_official_last_name": "SANTANGELO",
"authorized_official_first_name": "CHARLES",
"authorized_official_middle_name": "J.",
"authorized_official_title_or_position": "EXECUTIVE VP CFO",
"authorized_official_telephone_number": "570-321-3171",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "CPA FHFMA"
},
"taxonomies": [
{
"code": "261QE0700X",
"taxonomy_group": "",
"desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
"state": "PA",
"license": "041001",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS PIN",
"identifier": "393510",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST PRIORITY HEALTH PIN",
"identifier": "816867",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH AMERICA PIN",
"identifier": "394048",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEISINGER HEALTH PLAN PIN",
"identifier": "70159",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007563750011",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIHEALTH ADMINSTR PIN",
"identifier": "000070",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE MERCY HEALTH PIN",
"identifier": "1066310",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIHEALTH HMO AMER PIN",
"identifier": "20012697",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PIN",
"identifier": "394048",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ASSURANCE PIN",
"identifier": "394048",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLACK LUNG PROGRAM PIN",
"identifier": "396871",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Divine Providence Hospital",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Selinsgrove, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.