1326148164 NPI number — NORTH PENN COMPREHENSIVE HEALTH SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326148164 NPI number — NORTH PENN COMPREHENSIVE HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH PENN COMPREHENSIVE HEALTH SERVICES
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:
LAWRENCEVILLE LAUREL HEALTH CENTER
Provider Other Organization Name Type Code:
3
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:
1326148164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6A RIVERSIDE PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOSSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16912-1137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-662-1945
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 E LAWRENCE RD
Provider Second Line Business Practice Location Address:
LAWRENCEVILLE HEALTH CENTER
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-827-0125
Provider Business Practice Location Address Fax Number:
570-827-0129
Provider Enumeration Date:
09/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VANZILE
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
570-662-1945

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1000011720039 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".