Healthcare Provider Details

I. General information

NPI: 1245420066
Provider Name (Legal Business Name): MERCY TYLER HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 SR 6 W
TUNKHANNOCK PA
18657-6149
US

IV. Provider business mailing address

880 SR 6 W
TUNKHANNOCK PA
18657-6149
US

V. Phone/Fax

Practice location:
  • Phone: 570-836-2161
  • Fax: 570-836-1938
Mailing address:
  • Phone: 570-836-2161
  • Fax: 570-836-1938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number460201
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1007713080010
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: STEPHEN H FRANKO
Title or Position: CFO
Credential:
Phone: 570-348-7074