NPIMap

Organization Active NPI

Carbon-Schuylkill Community Hospital, Inc.

Doing business as St. Luke's Miner's Physician Assistants

  • Physician Assistant
  • Coaldale, PA
National Provider Identifier
1164726733
Registry record updated Dec 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Legal business name
CARBON-SCHUYLKILL COMMUNITY HOSPITAL, INC.
Doing business as
St. Luke's Miner's Physician Assistants
Practice address
360 W Ruddle St
Coaldale, PA 18218-1027
Phone
(570) 645-2131
NPI assigned
Dec 22, 2010
Last updated
Dec 22, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2010

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

Authorized official

Name
Thomas Lichtenwalner
Title
Senior Vice President
Phone
(610) 954-3301

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

360 W Ruddle St
Coaldale, PA 18218-1027

Mailing address

360 W Ruddle St
Coaldale, PA 18218-1027
Phone (570) 645-2131

Other names 1

  • St. Luke's Miner's Physician Assistants Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031117000015 PA Part B Supplier - Clinic/Group Practice 4486562030 Receives reassigned benefits from 244 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Coaldale, PA; Hazle Township, PA; Lehighton, PA; Mahanoy City, PA; McAdoo, PA; New Ringgold, PA; Tamaqua, PA

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1292976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292976000000",
    "number": "1164726733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 W RUDDLE ST",
            "city": "COALDALE",
            "state": "PA",
            "postal_code": "182181027",
            "telephone_number": "570-645-2131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 W RUDDLE ST",
            "city": "COALDALE",
            "state": "PA",
            "postal_code": "182181027",
            "telephone_number": "570-645-2131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARBON-SCHUYLKILL COMMUNITY HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-22",
        "last_updated": "2010-12-22",
        "status": "A",
        "authorized_official_last_name": "LICHTENWALNER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "610-954-3301"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Luke's Miner's Physician Assistants",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coaldale, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.