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Contact Information

PROVIDENCE PEDIATRICS, PC
338 RUSSELL AVENUE
WILLIAMSPORT, PA17701
 Phone: 570-326-5720
 Fax: 570-601-1522
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
 

Adolescent Medicine

2080A0000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for PROVIDENCE PEDIATRICS, PC

NPI Number 1265575955
LBN Legal business name PROVIDENCE PEDIATRICS, PC
Authorized official JOSEPH DEMAY - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 02/14/2007
Last updated 01/11/2011 - About 15 years ago
Identifiers
PA License # MD046306-L
PA License # MD046306L
PA Medicaid 0012712310004
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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