Healthcare Provider Details

I. General information

NPI: 1801336458
Provider Name (Legal Business Name): SCRANTON PRIMARY HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 ALDER ST
SCRANTON PA
18505-4126
US

IV. Provider business mailing address

959 WYOMING AVE
SCRANTON PA
18509-3023
US

V. Phone/Fax

Practice location:
  • Phone: 570-955-5524
  • Fax: 570-354-2113
Mailing address:
  • Phone: 570-344-3517
  • Fax: 570-344-9683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
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: MR. JOSEPH H HOLLANDER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 570-344-3517