PEDIATRIC PRACTICES OF NORTHEASTERN PA NPI 1730162678

NPI Information

NPI: 1730162678
Provider Name: PEDIATRIC PRACTICES OF NORTHEASTERN PA

Doing Business As: PEDIATRIC PRACTICES OF NORTHEASTERN PA

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
1837 FAIR AVE
HONESDALE, PA
ZIP 18431
Phone: (570) 253-5838
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PEDIATRIC PRACTICES OF NORTHEASTERN PA is a rural health clinic center in Honesdale, PA. PEDIATRIC PRACTICES OF NORTHEASTERN PA NPI is 1730162678. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Pediatric Practices Of Northeastern Pa.

The provider's business location address is:

1837 FAIR AVE
HONESDALE, PA
ZIP 18431-121
Phone: (570) 253-5838
Fax: (570) 253-1245

The provider's authorized official is Robert Morton .
The authorized official title is Partner and has the following contact phone number (570) 253-5838.

The enumeration date for this NPI number is 11/23/2005 and was last updated on 7/23/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208000000X	Pediatrics				No
2	261QR1300X	Clinic/Center	Rural Health			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100742260015	MEDICAID	PENNSYLVANIA
2	100742260016	MEDICAID	PENNSYLVANIA
3	100742260018	MEDICAID	PENNSYLVANIA
4	39-3887	OTHER	PENNSYLVANIA	CMS CERTIFICATION NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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