Basic Information
| Provider Information | |||||||||
| NPI: | 1669653176 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GEISINGER CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N ACADEMY AVE | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178223034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702715555 | ||||||||
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| Practice Location | |||||||||
| Address1: | 113 N MARKET ST | ||||||||
| Address2: | |||||||||
| City: | SELINSGROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178706060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703749005 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2007 | ||||||||
| LastUpdateDate: | 11/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | HOLDREN | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 5702715555 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
No ID Information.