1205938578 NPI number — RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205938578 NPI number — RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205938578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
276 E END CTR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILKES BARRE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18702-6970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-825-8741
Provider Business Mailing Address Fax Number:
570-825-8990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2795 SULLIVANS TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALLS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18615-7949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-704-4117
Provider Business Practice Location Address Fax Number:
570-388-2046
Provider Enumeration Date:
09/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ISKRA
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
570-825-8741

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1007296090015 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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