| Organization Name: | INDIANA REGIONAL MEDICAL CENTER |
| NPI Number: | 1104055946 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT A GONGAWARE (SR VICE PRESIDENT FOR FINANCE) |
| Mailing Address: | Indiana At Chestnut Ridge 25 Colony Blvd Blairsville |
| State: | PA US |
| Postal Code: | 15717 |
| Phone Number: | 7243577009 |
| Fax Number: | 7243577414 |
| NPI Enumeration Date: | 07/14/2009 |
| NPI Last Update Date: | 03/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | 090701 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |