Healthcare Provider Details

I. General information

NPI: 1154594687
Provider Name (Legal Business Name): COMMUNITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 MULBERRY ST
SCRANTON PA
18510-2369
US

IV. Provider business mailing address

1822 MULBERRY ST
SCRANTON PA
18510-2369
US

V. Phone/Fax

Practice location:
  • Phone: 570-558-3500
  • Fax: 570-558-3513
Mailing address:
  • Phone: 570-558-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1007456760027
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: CINDY L MULL
Title or Position: SYSTEM DIRECTOR ENROLLMENTS
Credential:
Phone: 570-271-6603