Provider Demographics
NPI:1104561091
Name:POCONO MEDICAL CENTER
Entity type:Organization
Organization Name:POCONO MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLITORIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-884-0974
Mailing Address - Street 1:330 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519-1691
Mailing Address - Country:US
Mailing Address - Phone:570-330-5180
Mailing Address - Fax:570-330-5024
Practice Address - Street 1:330 MAIN ST
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1691
Practice Address - Country:US
Practice Address - Phone:570-330-5180
Practice Address - Fax:570-330-5024
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEHIGH VALLEY HOSPITAL POCONO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-04
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy