Provider Demographics
NPI:1043392020
Name:NORTH PENN COMPREHENSIVE HEALTH SERVICES
Entity type:Organization
Organization Name:NORTH PENN COMPREHENSIVE HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MERYL
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:570-662-1955
Mailing Address - Street 1:7 WATER ST
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1126
Mailing Address - Country:US
Mailing Address - Phone:570-662-1955
Mailing Address - Fax:
Practice Address - Street 1:103 WEST AVE
Practice Address - Street 2:WELLSBORO LAUREL HEALTH CENTER
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1358
Practice Address - Country:US
Practice Address - Phone:570-724-1010
Practice Address - Fax:570-724-3970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
391848Medicare ID - Type UnspecifiedUGS
PA103562Medicare ID - Type Unspecified