Healthcare Provider Details

I. General information

NPI: 1487105912
Provider Name (Legal Business Name): COMMUNITY HEALTH HUB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 S WASHINGTON AVE
JERMYN PA
18433-1121
US

IV. Provider business mailing address

501 MADISON AVE
SCRANTON PA
18510-2401
US

V. Phone/Fax

Practice location:
  • Phone: 570-383-9934
  • Fax: 570-230-0023
Mailing address:
  • Phone: 570-343-2383
  • Fax: 570-343-3923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: RICHARD HAGER
Title or Position: VP FOR ADMINISTRATIVE AFFAIRS
Credential: FACHE
Phone: 570-343-2383