Healthcare Provider Details

I. General information

NPI: 1235424672
Provider Name (Legal Business Name): GEISINGER WYOMING VALLEY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 MARKET WAY
MOUNT POCONO PA
18344-3842
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-839-3633
  • Fax:
Mailing address:
  • Phone: 570-271-6211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number071801
License Number StatePA

VIII. Authorized Official

Name: CINDY MULL
Title or Position: DIRECTOR
Credential:
Phone: 570-271-6144