Healthcare Provider Details

I. General information

NPI: 1891867255
Provider Name (Legal Business Name): SHAMOKIN DAM HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3166 N OLD TRAIL
SHAMOKIN DAM PA
17876
US

IV. Provider business mailing address

3166 N OLD TRAIL
SHAMOKIN DAM PA
17876
US

V. Phone/Fax

Practice location:
  • Phone: 570-743-4333
  • Fax: 570-743-6012
Mailing address:
  • Phone: 570-743-4333
  • Fax: 570-743-6012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD032484E
License Number StatePA

VIII. Authorized Official

Name: DR. MICHAEL J DUNIGAN
Title or Position: PRESIDENT
Credential: DC
Phone: 570-743-4333