Healthcare Provider Details

I. General information

NPI: 1609883628
Provider Name (Legal Business Name): VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 EAST END BLVD.
WILKES-BARRE PA
18711
US

IV. Provider business mailing address

303 SCHOOLHOUSE RD.
TUNKHANNOCK PA
18657
US

V. Phone/Fax

Practice location:
  • Phone: 570-824-3521
  • Fax:
Mailing address:
  • Phone: 570-333-5224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberYM000449L
License Number StatePA

VIII. Authorized Official

Name: MR. GERALD ECKENRODE
Title or Position: RESPIRATORY THERAPIST
Credential: RRT
Phone: 570-824-3521