Divine Providence Hospital of the Sisters of Christian Charity

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

License

041001 Issued in PA

Legal business name

DIVINE PROVIDENCE HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY

Practice address

1100 Grampian Blvd
Williamsport, PA 17701-1909

Phone

(570) 326-8000

Fax

(570) 326-8601

NPI assigned

Oct 25, 2006

Organization subpart

Yes

Parent organization

DIVINE PROVIDENCE HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITYAs reported in NPPES

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

Authorized official

Name

Mr. Eric D Pohjala, FHFMA, FACHE

Title

Executive Vice President Cfo, Cpo

Phone

(570) 321-3171

Specialties & licenses 4

Addresses

Other identifiers 16

Other names 1

• Divine Providence Hospital Other name

Part of

Diabetes Center Divine

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488931200000",
    "number": "1861576993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 GRAMPIAN BLVD",
            "address_2": "2ND FLOOR",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011978",
            "telephone_number": "570-326-8676",
            "fax_number": "570-326-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 GRAMPIAN BLVD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011909",
            "telephone_number": "570-326-8000",
            "fax_number": "570-326-8601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE PROVIDENCE HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIVINE PROVIDENCE HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY",
        "enumeration_date": "2006-10-25",
        "last_updated": "2017-03-08",
        "status": "A",
        "authorized_official_last_name": "POHJALA",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT CFO, CPO",
        "authorized_official_telephone_number": "570-321-3171",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "FHFMA, FACHE"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "PA",
            "license": "041001",
            "primary": false
        },
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": "PA",
            "license": "041001",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "PA",
            "license": "041001",
            "primary": true
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "PA",
            "license": "041001",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007563750014",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH HMO AMER PIN",
            "identifier": "20012697",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG PROGRAM PIN",
            "identifier": "396871",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY HEALTH PIN",
            "identifier": "816867",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH ADMINSTR PIN",
            "identifier": "000070",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007563750031",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007563750036",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "394048",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH AMERICA PIN",
            "identifier": "394048",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007563750034",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007563750035",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER HEALTH PLAN PIN",
            "identifier": "70159",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007563750033",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE MERCY HEALTH PIN",
            "identifier": "1066310",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PIN",
            "identifier": "394048",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ASSURANCE PIN",
            "identifier": "394048",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Divine Providence Hospital",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Divine Providence Hospital of the Sisters of Christian Charity
• Divine Providence Hospital of the Sisters of Christian Charity
• Divine Providence Hospital of the Sisters of Christian Charity
• Divine Providence Hospital of the Sisters of Christian Charity
• Divine Providence Hospital of the Sisters of Christian Charity
• Divine Providence Hospital of the Sisters of Christian Charity
• Elizabeth A Dixon, OTR/L
• Boneita A Dodge
• Valerie Lynne Doebler, DC
• Deborah Dolan

• General Acute Care Hospital in Williamsport, PA
• Providers in Williamsport, PA by specialty
• General Acute Care Hospital in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2017; 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.