1568459436 NPI number — POCONO MEDICAL CENTER

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568459436 NPI number — POCONO MEDICAL CENTER

Employer Identification Number (EIN):

Provider Organization Name:

POCONO MEDICAL CENTER

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

LEHIGH VALLEY HOSPITAL POCONO

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:

1568459436

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

03/14/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

206 E BROWN ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

EAST STROUDSBURG

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

18301-3006

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

206 E BROWN ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

EAST STROUDSBURG

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

18301-3006

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

570-420-4923

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

10/05/2005

Authorized Official Last Name:

MARCHOZZI

Authorized Official First Name:

THOMAS

Authorized Official Middle Name:

Authorized Official Title or Position:

SR VP & CFO

Authorized Official Telephone Number:

484-862-3943

• Taxonomy code: 273R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 282N00000X , with the licence number: 072001 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 64492 . This is a "MED PLUS(THREE RIVERS HP)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0001455 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1007723970001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 25761 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1007723970013 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1007723970024 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1007723970002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1007723970014 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 390201 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 39S201 . This is a "PSYCH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 800053 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".