NPIMap

Organization Active NPI

Schuylkill Medical Center - East Norwegian Street

  • Surgical Physician Assistant
  • Pottsville, PA
National Provider Identifier
1073710166
Registry record updated Oct 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Legal business name
SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET
Practice address
700 E Norwegian St
Physican Billing
Pottsville, PA 17901-2710
Phone
(570) 621-8646
NPI assigned
Jul 2, 2007
Organization subpart
Yes
Parent organization
SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREETAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 16, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John E. Simodejka
Title
President & Chief Executive Officer
Phone
(717) 621-5111

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X PA
Surgical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AS0400X PA Primary
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X PA

Addresses

Primary practice location

700 E Norwegian St
Physican Billing
Pottsville, PA 17901-2710

Mailing address

700 E Norwegian St
Physican Billing
Pottsville, PA 17901-2710
Phone (570) 621-8646

Other identifiers 1

IdentifierTypeStateIssuer
1783963OtherPAHIGHMARK BS

Other names 1

  • Good Samaritan Regional Medical Center Former legal business name

National Provider Directory

National Provider Directory
Part of
Schuylkill Medical Center - East Norwegian Street Pharmacy

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224115200000",
    "number": "1073710166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 E NORWEGIAN ST",
            "address_2": "PHYSICAN BILLING",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179012710",
            "telephone_number": "570-621-8646",
            "fax_number": "570-621-4316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 E NORWEGIAN ST",
            "address_2": "PHYSICAN BILLING",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179012710",
            "telephone_number": "570-621-8646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET",
        "enumeration_date": "2007-07-02",
        "last_updated": "2008-10-16",
        "status": "A",
        "authorized_official_last_name": "SIMODEJKA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT & CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "717-621-5111"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "PA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BS",
            "identifier": "1783963",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Good Samaritan Regional Medical Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Pottsville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 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.

Verify at the official NPI Registry.