1407838055 NPI number — HEALTH POCONOS, INC

Table of content: (NPI 1407838055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407838055 NPI number — HEALTH POCONOS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH POCONOS, INC
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:
6
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:
1407838055
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 COMMUNITY DR
Provider Second Line Business Mailing Address:
207
Provider Business Mailing Address City Name:
TOBYHANNA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18466-8985
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-839-9975
Provider Business Mailing Address Fax Number:
570-839-9274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 COMMUNITY DR
Provider Second Line Business Practice Location Address:
105
Provider Business Practice Location Address City Name:
TOBYHANNA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18466-8985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-839-9975
Provider Business Practice Location Address Fax Number:
570-839-9274
Provider Enumeration Date:
11/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MAASSEN
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF COMPLIANCE
Authorized Official Telephone Number:
414-908-8119

Provider Taxonomy Codes

  • Taxonomy code: 261QR0401X , with the licence number:  394532 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: E56832 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0510083000 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 81386 . This is a "THREE RIVERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2451453209 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50004997 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 543451 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2Y4263 . This is a "HEALTHNET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001467795 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: RI556832 . This is a "BLUE SHIELD #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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