PEDIATRIC PRACTICES OF NORTHEASTERN PA; NPI #1578895538

Contact Information

PEDIATRIC PRACTICES OF NORTHEASTERN PA

27B WOODLANDS DR
WAYMART, PA 18472-9366

Phone: 570-448-9550
Fax: 570-488-9553
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Rural Health	261QR1300X	B4[14]	Rural Health Clinic
Pediatrics	208000000X	37	Physician/Pediatric Medicine

Indicates primary specialty

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NPI Profile & details for PEDIATRIC PRACTICES OF NORTHEASTERN PA

NPI Number 1578895538

LBN Legal business name PEDIATRIC PRACTICES OF NORTHEASTERN PA

Authorized official ROBERT MORTON - (PARTNER)

Entity Organization

Organization subpart ¹ No

Enumeration date 02/02/2010

Last updated 07/23/2019 - About 7 years ago

Identifiers

PA	Medicaid	1007422260018
PA	Other	39-3906	CMS CERTIFICATION NUMBER

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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