Healthcare Provider Details

I. General information

NPI: 1114978608
Provider Name (Legal Business Name): GEISINGER CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MEDICAL CENTER DRIVE
PHILIPSBURG PA
16866
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-3034
US

V. Phone/Fax

Practice location:
  • Phone: 814-342-8001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KENNETH HOLDREN
Title or Position: CAO
Credential:
Phone: 570-271-5490