1184140063 NPI number — THE WRIGHT CENTER MEDICAL GROUP

Table of content: (NPI 1184140063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184140063 NPI number — THE WRIGHT CENTER MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE WRIGHT CENTER MEDICAL GROUP
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:
THE WRIGHT CENTER MEDICAL GROUP COE
Provider Other Organization Name Type Code:
5
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:
1184140063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 S WASHINGTON AVE STE 1000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCRANTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18505-3814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-591-5159
Provider Business Mailing Address Fax Number:
570-343-3923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 S WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERMYN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18433-1121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-383-9934
Provider Business Practice Location Address Fax Number:
570-230-0023
Provider Enumeration Date:
08/22/2017

Additional Information

Authorized Official

Authorized Official Last Name:
DANIELS
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
570-343-2383

Provider Taxonomy Codes

  • Taxonomy code: 207RA0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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