Provider Demographics
NPI:1063540011
Name:GEISINGER MEDICAL CENTER
Entity type:Organization
Organization Name:GEISINGER MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SYSTEM DIRECTOR CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-271-6603
Mailing Address - Street 1:5 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18705
Mailing Address - Country:US
Mailing Address - Phone:570-241-5642
Mailing Address - Fax:
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822
Practice Address - Country:US
Practice Address - Phone:570-574-6224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEISINGER MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-01
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
0483620001OtherDME
0483620001OtherDME