| NPI | 1518576412 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINDY L MULL System Director Credentialing 570-271-6144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral |
| 133N00000X Nutritionist | |
| 172V00000X Community Health Worker | |
| 207RI0001X Internal Medicine Clinical & Laboratory Immunology | |
| 207ZP0105X Pathology Clinical Pathology/Laboratory Medicine | |
| 2085B0100X Radiology Body Imaging | |
| 2085U0001X Radiology Diagnostic Ultrasound | |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2020-07-28 |