MEDICARE: HAZLETON HEALTH & WELLNESS CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346387933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAZLETON HEALTH & WELLNESS CENTER

Provider Business Mailing Address
First Line	:	700 E BROAD ST
Second Line	:
City	:	HAZLETON
State	:	PA
Zip	:	18201-6835
Country	:	US
Telephone Number	:	570-501-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 MOISEY DR
Second Line	:
City	:	HAZLETON
State	:	PA
Zip	:	18202-9297
Country	:	US
Telephone Number	:	570-501-4000
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. WILLIAM C BAUER
Credential	:
Telephone Number	:	570-501-6293

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	02/22/2008

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Directions to “HAZLETON HEALTH & WELLNESS CENTER ” Practice Location

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