1811210636 NPI number — MATERNAL & FAMILY HEALTH SERVICES INC

Table of content: (NPI 1811210636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811210636 NPI number — MATERNAL & FAMILY HEALTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MATERNAL & FAMILY HEALTH SERVICES 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:
1811210636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 PUBLIC SQ
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
WILKES BARRE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18701-1702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-826-1777
Provider Business Mailing Address Fax Number:
570-823-3040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 W CHESTNUT ST
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
HAZLETON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18201-6423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-459-1805
Provider Business Practice Location Address Fax Number:
570-501-1194
Provider Enumeration Date:
03/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GERMINO
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT FINANCE & PLANNING
Authorized Official Telephone Number:
570-826-1777

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  MD055164L , 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: 0015798710009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0016466420007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1026262170003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1025994230002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1026261910005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007678420035 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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