Healthcare Provider Details

I. General information

NPI: 1639747462
Provider Name (Legal Business Name): GEISINGER CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

293 PATRIOT LN
STATE COLLEGE PA
16803-1539
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-9800
US

V. Phone/Fax

Practice location:
  • Phone: 814-272-6770
  • Fax: 814-283-6415
Mailing address:
  • Phone: 570-271-6144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CINDY L MULL
Title or Position: DIRECTOR
Credential:
Phone: 570-271-6603