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Schuylkill Medical Center - South Jackson Street

Organization Active NPI Psychiatry Physician · Pottsville, PA

NPI 1982606802 · NPPES record last updated Jul 16, 2013

Key facts

NPI
1982606802
Entity type
Organization (NPI type 2)
Primary specialty
Psychiatry Physician 2084P0800X
Legal business name
SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET
Practice address
420 S Jackson St
Pottsville, PA 17901-3625
Phone
(570) 621-5000
Fax
(570) 622-8221
NPI assigned
Aug 11, 2005
Organization subpart
No

Authorized official

Name
John E. Simodejka
Title
President and Ceo
Phone
(570) 621-5111

Other NPIs with the same Medicare PAC ID 5

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in PA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040408001006 PA Part B Supplier - Hospital Department(S) 4183525959 Practice locations: Pottsbille, PA; Pottsville, PA

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 2084P0800X Yes

Addresses

Primary practice location

420 S Jackson St
Pottsville, PA 17901-3625

Mailing address

420 S Jackson St
Pottsville, PA 17901-3625
Phone (570) 621-5000

Other names

  • Schuylkill Medical Center - South Jackson Street Psychiatry Group Doing business as

Other providers in Pottsville, PA

All providers in Pottsville, PA · Psychiatry Physician in Pennsylvania

Sources for this page

Verify at the official NPI Registry.