Healthcare Provider Details

I. General information

NPI: 1699762849
Provider Name (Legal Business Name): GEISINGER HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 VALLEY VIEW RD
STILLWATER PA
17878-9245
US

IV. Provider business mailing address

94 VALLEY VIEW RD
STILLWATER PA
17878-9245
US

V. Phone/Fax

Practice location:
  • Phone: 570-864-0131
  • Fax:
Mailing address:
  • Phone: 570-864-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT001270A
License Number StatePA

VIII. Authorized Official

Name: MR. JAMES ALBERT SHEA JR.
Title or Position: CERTIFIED ATHLETIC TRAINER
Credential: ATC
Phone: 570-864-0131