1578559647 NPI number — CITY OF WILKES BARRE

Table of content: (NPI 1578559647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578559647 NPI number — CITY OF WILKES BARRE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF WILKES BARRE
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:
1578559647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 320
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNMORE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18512-0320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-341-9340
Provider Business Mailing Address Fax Number:
570-341-3237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 N WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18705-1853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-208-4112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DELANEY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
570-208-4260

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  03168 , 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: PA0492 . This is a "QUALMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200526 . This is a "BCBS OF PA BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: PA0492 . This is a "ACS NET COMMERCIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1105166 . This is a "KEYSTONE MERCY HMO DPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 590000772 . This is a "UNITED HC RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: PA0492 . This is a "ACS HEALTH NET HMO MDC" identifier . This identifiers is of the category "OTHER".
  • Identifier: PA0492 . This is a "PHS HEALTH PLAN HMO MDC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20005968 . This is a "AMERIHEALTH MERCY HMO DPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 077895 . This is a "FIRST PRIORITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 108334 . This is a "HEALTH PARTNERS HMO DPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 863165 . This is a "UMWA HEALTH & RETIREMENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 008461930003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 086316500 . This is a "FEDERAL BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43244 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 119571300 . This is a "ACS BENEFITS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 119571300 . This is a "DEPT OF LABOR WORK COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: PA0492 . This is a "PHS HEALTH PLAN COMMERICA" identifier . This identifiers is of the category "OTHER".




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