Basic Information
| Provider Information | |||||||||
| NPI: | 1669768214 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GEISINGER WYOMING VALLEY MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N ACADEMY AVE | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178224903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702716211 | ||||||||
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| Practice Location | |||||||||
| Address1: | 110 TRIEBLE RD | ||||||||
| Address2: | |||||||||
| City: | TUNKHANNOCK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 186573816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702715555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2011 | ||||||||
| LastUpdateDate: | 06/27/2013 | ||||||||
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| AuthorizedOfficialLastName: | BUCKLEY | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CAO | ||||||||
| AuthorizedOfficialTelephone: | 5702715555 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 282N00000X | 071801 | PA | Y | Hospitals | General Acute Care Hospital |
No ID Information.