Healthcare Provider Details

I. General information

NPI: 1225781602
Provider Name (Legal Business Name): RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 KING STREET
LAPORTE PA
18626-0157
US

IV. Provider business mailing address

276 E END CTR
WILKES BARRE PA
18702-6970
US

V. Phone/Fax

Practice location:
  • Phone: 570-946-5201
  • Fax:
Mailing address:
  • Phone: 570-946-5201
  • Fax: 570-825-9990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier731976
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICARE PTAN
# 2
Identifier=========
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MATTHEW J ISKRA
Title or Position: CFO
Credential: MBA
Phone: 570-825-8741