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General NPI Number Information
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NPI Number | 1669653176
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Entity Type | Organization
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Legal Business Name | GEISINGER CLINIC
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 113 N MARKET ST
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City | SELINSGROVE
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State | PA
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Zip | 17870-6060
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Country | US
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Telephone | 570-374-9005
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Fax |
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Provider Business Mailing Address
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Address Line | 100 N ACADEMY AVE
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City | DANVILLE
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State | PA
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Zip | 17822-3034
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Country | US
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Telephone | 570-271-5555
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Fax |
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Authorized Official
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Title or Position | VP
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Name | KENNETH HOLDREN
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Credential |
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Telephone | 570-271-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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