Basic Information
| Provider Information | |||||||||
| NPI: | 1689265233 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH PENN COMPREHENSIVE HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 W WELLSBORO ST | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 169331411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706621945 | ||||||||
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| Practice Location | |||||||||
| Address1: | 116 SEYMOUR ST | ||||||||
| Address2: | |||||||||
| City: | BLOSSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 169121418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706383468 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2021 | ||||||||
| LastUpdateDate: | 01/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | GILBERT | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | MERYL | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5706621955 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223D0001X | N | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Dental Public Health | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.