Basic Information
| Provider Information | |||||||||
| NPI: | 1033391057 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MATERNAL AND FAMILY HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 315 COLFAX AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | SCRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185102524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702085544 | ||||||||
| FaxNumber: | 5702085548 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 COLFAX AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | SCRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185102524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702085544 | ||||||||
| FaxNumber: | 5702085548 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2007 | ||||||||
| LastUpdateDate: | 12/28/2007 | ||||||||
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| AuthorizedOfficialLastName: | MACKEY | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5702085544 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 1007678420031 | 05 | PA | MEDICAID |