Healthcare Provider Details

I. General information

NPI: 1497366207
Provider Name (Legal Business Name): HOSPITALIST SERVICES AT MOSES TAYLOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 QUINCY AVE
SCRANTON PA
18510-1724
US

IV. Provider business mailing address

PO BOX 69233
BALTIMORE MD
21264-9233
US

V. Phone/Fax

Practice location:
  • Phone: 570-770-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: TIM DELBRUGGE
Title or Position: CFO
Credential:
Phone: 301-693-8707