Healthcare Provider Details

I. General information

NPI: 1649748005
Provider Name (Legal Business Name): THE WRIGHT CENTER MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 S WASHINGTON AVE
JERMYN PA
18433-1121
US

IV. Provider business mailing address

501 S WASHINGTON AVE STE 1000
SCRANTON PA
18505-3814
US

V. Phone/Fax

Practice location:
  • Phone: 570-230-0019
  • Fax: 570-230-0013
Mailing address:
  • Phone: 570-343-2383
  • Fax: 570-343-3923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier001508252
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: RONALD DANIELS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 570-343-2383