1053507293 NPI number — JOHN SCHELAND, DPM PC

Table of content: (NPI 1053507293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053507293 NPI number — JOHN SCHELAND, DPM PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN SCHELAND, DPM PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053507293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
630 CLARK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLD FORGE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18518-1512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-457-1681
Provider Business Mailing Address Fax Number:
570-586-5671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 ABINGTON EXECUTIVE PARK
Provider Second Line Business Practice Location Address:
STE 7
Provider Business Practice Location Address City Name:
CLARKS SUMMIT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18411-2268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-586-5687
Provider Business Practice Location Address Fax Number:
570-586-5671
Provider Enumeration Date:
09/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHELAND
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-586-5687

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  SC004413L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 739M . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 6211270 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 739M . This is a "GEISINGER GOLD HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1987975 . This is a "BC/BS/ FIRST PRIORITY LIFE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7872162 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1987975 . This is a "BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 821869 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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