NPIMap

Organization Active NPI

Indiana Regional Medical Center

  • Dental Clinic/Center
  • Indiana, PA
National Provider Identifier
1770614919
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
090701 Issued in PA
Legal business name
INDIANA REGIONAL MEDICAL CENTER
Practice address
835 Hospital Road
Pediatric & Adolescent Dental Clinic
Indiana, PA 15701-0788
Phone
(724) 357-6960
Fax
(724) 357-6961
NPI assigned
Mar 8, 2007
Last updated
Jul 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

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

Authorized official

Name
Mr. Michael F Ickowski, CPA, MBA
Title
Chief Financial Officer
Phone
(724) 357-7008

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 090701 PA Primary

Addresses

Primary practice location

835 Hospital Road
Pediatric & Adolescent Dental Clinic
Indiana, PA 15701-0788

Mailing address

835 Hospital Road
PO Box 788
Indiana, PA 15701-0788
Phone (724) 357-7009

Other identifiers 1

IdentifierTypeStateIssuer
100771353 0003MedicaidPA

National Provider Directory

National Provider Directory
Tax ID family
Indiana Hosp15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720569600000",
    "number": "1770614919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 HOSPITAL ROAD",
            "address_2": "PO BOX 788",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157010788",
            "telephone_number": "724-357-7009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 HOSPITAL ROAD",
            "address_2": "PEDIATRIC & ADOLESCENT DENTAL CLINIC",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157010788",
            "telephone_number": "724-357-6960",
            "fax_number": "724-357-6961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A",
        "authorized_official_last_name": "ICKOWSKI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "724-357-7008",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA, MBA"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "PA",
            "license": "090701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100771353 0003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indiana, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; 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.