MEDICARE: GEISINGER CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician
2	2085R0202X	Diagnostic Radiology Physician
3	363A00000X	Physician Assistant
4	363L00000X	Nurse Practitioner
5	291U00000X	Clinical Medical Laboratory	PA
6	332B00000X	Durable Medical Equipment & Medical Supplies
7	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1306897731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEISINGER CLINIC

Provider Business Mailing Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-3034
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 DALLAS SHOPPING CTR
Second Line	:	ROUTE 309
City	:	DALLAS
State	:	PA
Zip	:	18612-1231
Country	:	US
Telephone Number	:	570-675-0874
Fax Number	:

Authorized Official
Title or Position	:	CAO
Name	:	KENNETH HOLDREN
Credential	:
Telephone Number	:	570-271-5490

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	06/27/2008

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Directions to “GEISINGER CLINIC ” Practice Location

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