Healthcare Provider Details

I. General information

NPI: 1447657770
Provider Name (Legal Business Name): MS. ELIZABETH HELEN AMEIGH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PENN AVE
SCRANTON PA
18503-1213
US

IV. Provider business mailing address

401 PENN AVE
SCRANTON PA
18503-1213
US

V. Phone/Fax

Practice location:
  • Phone: 570-961-4360
  • Fax: 570-961-1942
Mailing address:
  • Phone: 570-961-4360
  • Fax: 570-961-1942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberTE1003400
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: