Healthcare Provider Details

I. General information

NPI: 1326148164
Provider Name (Legal Business Name): NORTH PENN COMPREHENSIVE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 E LAWRENCE RD LAWRENCEVILLE HEALTH CENTER
LAWRENCEVILLE PA
16929
US

IV. Provider business mailing address

6A RIVERSIDE PLZ
BLOSSBURG PA
16912-1137
US

V. Phone/Fax

Practice location:
  • Phone: 570-827-0125
  • Fax: 570-827-0129
Mailing address:
  • Phone: 570-662-1945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ANGELA M. VANZILE
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 570-662-1945