Basic Information
| Provider Information | |||||||||
| NPI: | 1184993461 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCRANTON QUINCY HOSPITAL COMPANY LLC | ||||||||
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| OtherOrganizationName: | MOSES TAYLOR HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 QUINCY AVE | ||||||||
| Address2: | |||||||||
| City: | SCRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185101724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703402882 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 QUINCY AVE | ||||||||
| Address2: | |||||||||
| City: | SCRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185101724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703402882 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2011 | ||||||||
| LastUpdateDate: | 12/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | HOLTSFORD | ||||||||
| AuthorizedOfficialFirstName: | LAURIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTH OFFICIAL / DIR BO SUP | ||||||||
| AuthorizedOfficialTelephone: | 6154657466 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SCRANTON QUINCY HOSPITAL COMPANY LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.