Healthcare Provider Details

I. General information

NPI: 1942252002
Provider Name (Legal Business Name): HAZLETON AREA SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W 23RD ST
HAZLETON PA
18202-1647
US

IV. Provider business mailing address

1515 W 23RD ST
HAZLETON PA
18202-1647
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-3111
  • Fax: 570-459-3211
Mailing address:
  • Phone: 570-459-3111
  • Fax: 570-459-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0012945400003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. ANTHONY RYBA
Title or Position: SECRETARY/BUSINESS MANAGER
Credential:
Phone: 570-459-3111