NPIMap

Organization Active NPI

The Carbon-Schuylkill Community Hospital, Inc.

Doing business as St. Luke's Miners Memorial Hospital ER

  • Emergency Medicine Physician
  • Coaldale, PA
National Provider Identifier
1194891010
Registry record updated Jan 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
THE CARBON-SCHUYLKILL COMMUNITY HOSPITAL, INC.
Doing business as
St. Luke's Miners Memorial Hospital ER
Practice address
360 W Ruddle St
Coaldale, PA 18218-1027
Phone
(570) 645-8127
Fax
(570) 645-8148
NPI assigned
Nov 24, 2006
Last updated
Jan 23, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2013

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

Authorized official

Name
Thomas Lichtenwalner
Title
Associate VP Finance
Phone
(610) 954-3383

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 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) 645-8127

Other identifiers 1

IdentifierTypeStateIssuer
1007454700008MedicaidPA

Other names 1

  • St. Luke's Miners Memorial Hospital ER 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
Practice locations: Coaldale, PA; Hazle Township, PA; Lehighton, PA; Mahanoy City, PA; McAdoo, PA; New Ringgold, PA; Tamaqua, PA

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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 247

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 247

NPI Registry JSON

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

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358899200000",
    "number": "1194891010",
    "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": "570-645-8127",
            "fax_number": "570-645-8148"
        },
        {
            "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": "570-645-8127",
            "fax_number": "570-645-8148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CARBON-SCHUYLKILL COMMUNITY HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-24",
        "last_updated": "2013-01-23",
        "status": "A",
        "authorized_official_last_name": "LICHTENWALNER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "ASSOCIATE VP FINANCE",
        "authorized_official_telephone_number": "610-954-3383"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007454700008",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Luke's Miners Memorial Hospital ER",
            "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 Jan 23, 2013; 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.