Healthcare Provider Details

I. General information

NPI: 1194186957
Provider Name (Legal Business Name): LAKE SCRANTON URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 MOOSIC ST SUITE 3
SCRANTON PA
18505-2105
US

IV. Provider business mailing address

1141 MOOSIC ST SUITE 3
SCRANTON PA
18505-2105
US

V. Phone/Fax

Practice location:
  • Phone: 570-800-5926
  • Fax: 570-955-5556
Mailing address:
  • Phone: 570-800-5926
  • Fax: 570-955-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRIANNE BALCHUNE
Title or Position: OFFICE MANAGER
Credential:
Phone: 570-800-5926