1629170980 NPI number — RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA

Table of content: (NPI 1629170980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629170980 NPI number — RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
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:
MONROE-NOXEN 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:
1629170980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
276 E END CTR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILKES BARRE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18702-6970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-825-8741
Provider Business Mailing Address Fax Number:
570-825-8990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2888 SR 29 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18636-7854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-704-4234
Provider Business Practice Location Address Fax Number:
570-298-2148
Provider Enumeration Date:
09/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ISKRA
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
570-825-8741

Provider Taxonomy Codes

  • 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" .

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

  • Identifier: 1007296090011 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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