NPIMap

Organization Active NPI

Schuylkill Medical Center - South Jackson Street Spu

  • Ambulatory Surgical Clinic/Center
  • Pottsville, PA
National Provider Identifier
1568503449
Registry record updated Jan 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET SPU
Practice address
420 S Jackson St
Pottsville, PA 17901-3625
Phone
(570) 621-5142
Fax
(570) 621-5113
NPI assigned
Feb 12, 2007
Last updated
Jan 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2025

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

Authorized official

Name
Thomas Marchozzi
Title
Sr VP & Cfo
Phone
(484) 862-3943

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X PA Primary

Addresses

Primary practice location

420 S Jackson St
Pottsville, PA 17901-3625

Mailing address

420 S Jackson St
Pottsville, PA 17901-3625
Phone (570) 621-5142

Other identifiers 1

IdentifierTypeStateIssuer
100760725-0016MedicaidPA

Other names 1

  • The Pottsville Hospital and Warne Clinic SPU Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Pottsville Hosp Path10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736380800000",
    "number": "1568503449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 S JACKSON ST",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179013625",
            "telephone_number": "570-621-5142",
            "fax_number": "570-621-5113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 S JACKSON ST",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179013625",
            "telephone_number": "570-621-5142",
            "fax_number": "570-621-5113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET SPU",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A",
        "authorized_official_last_name": "MARCHOZZI",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "SR VP & CFO",
        "authorized_official_telephone_number": "484-862-3943"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100760725-0016",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Pottsville Hospital and Warne Clinic SPU",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "The Pottsville Hospital and Warne Clinic SPU",
            "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 Jan 9, 2025; 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.