Provider Demographics
NPI:1396075891
Name:MATERNAL & FAMILY HEALTH SERVICES, INC
Entity type:Organization
Organization Name:MATERNAL & FAMILY HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE & PLANNIN
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GERMINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-826-1777
Mailing Address - Street 1:15 PUBLIC SQ
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-1702
Mailing Address - Country:US
Mailing Address - Phone:570-826-1777
Mailing Address - Fax:570-823-3040
Practice Address - Street 1:640 MADISON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1631
Practice Address - Country:US
Practice Address - Phone:570-961-5550
Practice Address - Fax:570-961-3844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065507L208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007678420045Medicaid
PA1030047770005Medicaid
PA0017358870011Medicaid
PA1029682400005Medicaid