MEDICARE: NORTH PENN COMPREHENSIVE HEALTH SERVICES

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	261QF0400X	Federally Qualified Health Center (FQHC)

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	:	1750461455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH PENN COMPREHENSIVE HEALTH SERVICES

Provider Business Mailing Address
First Line	:	6A RIVERSIDE PLZ
Second Line	:
City	:	BLOSSBURG
State	:	PA
Zip	:	16912-1137
Country	:	US
Telephone Number	:	570-662-1945
Fax Number	:

Provider Business Practice Location Address
First Line	:	416 S MAIN ST
Second Line	:	MANSFIELD LAUREL HEALTH CENTER
City	:	MANSFIELD
State	:	PA
Zip	:	16933-1510
Country	:	US
Telephone Number	:	570-662-2002
Fax Number	:	570-662-2025

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	ANGELA M. VANZILE
Credential	:
Telephone Number	:	570-662-1945

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	06/08/2022

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