Basic Information
| Provider Information | |||||||||
| NPI: | 1134536519 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GEISINGER CLINIC | ||||||||
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| OtherOrganizationName: | PRIMMED MEDICAL GRP OLD FORGE IN COLLABORATION W/GEISINGER CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N ACADEMY AVE | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178224903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702715555 | ||||||||
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| Practice Location | |||||||||
| Address1: | 939 MOOSIC ROAD | ||||||||
| Address2: | |||||||||
| City: | OLD FORGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704713506 | ||||||||
| FaxNumber: | 5704713507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2014 | ||||||||
| LastUpdateDate: | 11/12/2014 | ||||||||
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| AuthorizedOfficialLastName: | MULL | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR REVENUE MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 5702715555 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.