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RRC390133-57 LEHIGH VALLEY HOSPITAL (Terminated)
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Main Details
Name
LEHIGH VALLEY HOSPITAL
Subdivision Name
Lehigh Valley Hospital - CARDIAC DIAGNOSTIC CENTER - 127
Type
Rural Referral Center
Rural
No
340B ID
RRC390133-57
Medicare Provider Number
390133
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/12/2017
Participating Start Date
1/1/2018
Participating Approval Date
10/26/2017
Last Recertification Date
8/25/2022
Termination Date
Termination Reason
1/1/2023
Change of covered entity type
Contacts
Authorizing Official
Lehigh Valley Health Network
Thomas Marchozzi, Executive Vice President & Chief Financial Officer
(484) 862-3943
Primary Contact
Lehigh Valley Health Network
Stephen Patrick Molitoris, Vice President
(484) 884-0974
Addresses
Street Address
1627 West Chew Street, 1st Fl.
Allentown, PA 18102
Billing Address
Lehigh Valley Hospital
2100 Mack Blvd
Allentown, PA 18103
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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