Basic Information
| Provider Information | |||||||||
| NPI: | 1154372530 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GEISINGER CLINIC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GEISINGER MEDICAL GROUP PITTSTON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N ACADEMY AVE | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178214903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702716621 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 42 N MAIN ST. | ||||||||
| Address2: | |||||||||
| City: | PITTSTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706540880 | ||||||||
| FaxNumber: | 5706559857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 09/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | MULL | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR CREDENTIALS & ENROLLMENT | ||||||||
| AuthorizedOfficialTelephone: | 5702716603 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0105X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 291U00000X | PA | N | Laboratories | Clinical Medical Laboratory | 207ZP0105X | PA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | 332B00000X | PA | N | Suppliers | Durable Medical Equipment & Medical Supplies | 207Q00000X | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.