1316075419 NPI number — ST. JOSEPH'S CENTER

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316075419 NPI number — ST. JOSEPH'S CENTER

Employer Identification Number (EIN):

Provider Organization Name:

ST. JOSEPH'S 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:

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:

1316075419

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

06/16/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2010 ADAMS AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SCRANTON

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

18509-1508

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

570-342-8379

Provider Business Mailing Address Fax Number:

570-963-1286

Provider First Line Business Practice Location Address:

2010 ADAMS AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SCRANTON

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

18509-1508

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

570-342-8379

Provider Business Practice Location Address Fax Number:

570-963-1286

Provider Enumeration Date:

03/01/2007

Authorized Official Last Name:

GORDON

Authorized Official First Name:

ROBERT

Authorized Official Middle Name:

Authorized Official Title or Position:

VICE PRESIDENT CFO

Authorized Official Telephone Number:

570-963-1273

• Taxonomy code: 225100000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 225800000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 225A00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 225X00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 235Z00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 251E00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 315P00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 320900000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 385HR2060X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 1000013880031 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000013880061 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000013880038 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000013880054 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000013880055 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1576764PT . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1000013880034 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000013880040 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000013880046 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000013880047 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000013880048 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1576770ST . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1000013880001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000013880049 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000013880050 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000013880056 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000013880058 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000013880063 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000013880057 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000013880059 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".