Basic Information
| Provider Information | |||||||||
| NPI: | 1649305129 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GEISINGER WYOMING VALLEY MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 LAKEVIEW DR | ||||||||
| Address2: | |||||||||
| City: | MOOSIC | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702145642 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 E MOUNTAIN DR | ||||||||
| Address2: | |||||||||
| City: | WILKES BARRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708267300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 06/12/2013 | ||||||||
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| AuthorizedOfficialLastName: | TAPSCOTT | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 5702149773 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GEISINGER WYOMING VALLEY | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 282N00000X | 148901 | PA | Y | Hospitals | General Acute Care Hospital |
No ID Information.