1912940669 NPI number — POCONO MOUNTAIN SCHOOL DISTRICT

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 1912940669 NPI number — POCONO MOUNTAIN SCHOOL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POCONO MOUNTAIN SCHOOL DISTRICT
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:
1912940669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
POCONO MOUNTAIN SCHOOL RD
Provider Second Line Business Mailing Address:
PO BOX 200
Provider Business Mailing Address City Name:
SWIFTWATER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18370-0200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-839-7121
Provider Business Mailing Address Fax Number:
570-895-4522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
POCONO MOUNTAIN SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWIFTWATER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18370-0200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-839-7121
Provider Business Practice Location Address Fax Number:
570-895-4522
Provider Enumeration Date:
06/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KELLY
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
V
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
570-839-7121

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , 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: 0014451610001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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