=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699082495
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILKES-BARRE HOSPITAL COMPANY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2010
-----------------------------------------------------
Last Update Date | 09/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 575 N RIVER ST
-----------------------------------------------------
City | WILKES BARRE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18764-0999
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-829-8111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7100 COMMERCE WAY SUITE 180
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-2829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-465-7626
-----------------------------------------------------
Fax | 615-465-3007
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DEBBIE BREWER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-465-7626
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------