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 | 261Q00000X | Clinic/Center | | 134301 | PENNSYLVANIA | No |
| 2 | 261QA1903X | Clinic/Center | Ambulatory Surgical | 134301 | PENNSYLVANIA | No |
| 3 | 282NC0060X | General Acute Care Hospital | Critical Access | 134301 | PENNSYLVANIA | 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 | 391301 | OTHER | PENNSYLVANIA | HEALTH AMERICA PIN |
| 2 | 1007607800014 | MEDICAID | PENNSYLVANIA | |
| 3 | 29430 | OTHER | PENNSYLVANIA | GEISINGER HEALTH PLAN PIN |
| 4 | 058074 | OTHER | PENNSYLVANIA | FIRST PRIORITY HEALTH PIN |
| 5 | 391301 | OTHER | PENNSYLVANIA | BLUE CROSS PIN |
| 6 | 000111 | OTHER | PENNSYLVANIA | AMERIHEALTH ADMINSTR PIN |
| 7 | 1004905 | OTHER | PENNSYLVANIA | KEYSTONE MERCY HEALTH PIN |
| 8 | 20020966 | OTHER | PENNSYLVANIA | AMERIHEALTH HMO AMER PIN |
| 9 | 1007607800007 | MEDICAID | PENNSYLVANIA | |
| 10 | 309502 | OTHER | PENNSYLVANIA | BLACK LUNG PROGRAM PIN |
| 11 | 391301 | OTHER | PENNSYLVANIA | HEALTH ASSURANCE PIN |
| 12 | 391301 | OTHER | PENNSYLVANIA | AETNA PIN |
