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RRC390133-102 LEHIGH VALLEY HOSPITAL (Terminated)
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Main Details
Name
LEHIGH VALLEY HOSPITAL
Subdivision Name
Lehigh Valley Hospital - POST OPERATIVE UNIT at TILGHMAN - 209
Type
Rural Referral Center
Rural
No
340B ID
RRC390133-102
Medicare Provider Number
390133
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/12/2018
Participating Start Date
4/1/2018
Participating Approval Date
2/14/2018
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
4815 WEST TILGHMAN STREET
Allentown, PA 18104
Billing Address
Lehigh Valley Hospital
2100 Mack Blvd
Allentown, PA 18103
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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