Provider Demographics
NPI:1790811172
Name:GEISINGER SOUTH WILKES BARRE
Entity type:Organization
Organization Name:GEISINGER SOUTH WILKES BARRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAPSCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-214-7993
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 1:25 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18765
Practice Address - Country:US
Practice Address - Phone:570-214-9763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEISINGER SOUTH WILKES BARRE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-27
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA390169Medicare Oscar/Certification