Healthcare Provider Details

I. General information

NPI: 1801871579
Provider Name (Legal Business Name): SCRANTON PRIMARY HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 WYOMING AVE
SCRANTON PA
18509-3023
US

IV. Provider business mailing address

959 WYOMING AVE.
SCRANTON PA
18509-3023
US

V. Phone/Fax

Practice location:
  • Phone: 570-344-3517
  • Fax: 570-344-6839
Mailing address:
  • Phone: 570-344-3517
  • Fax: 570-344-6839

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:

# 1
Identifier1007288710003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: JOSEPH H HOLLANDER
Title or Position: CEO
Credential:
Phone: 570-344-3517