Provider Demographics
NPI:1871695148
Name:RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
Entity type:Organization
Organization Name:RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-825-8741
Mailing Address - Street 1:1084 ROUTE 315
Mailing Address - Street 2:
Mailing Address - City:WILKES-BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-7012
Mailing Address - Country:US
Mailing Address - Phone:570-825-8741
Mailing Address - Fax:570-825-8990
Practice Address - Street 1:75 PINEAPPLE STREET
Practice Address - Street 2:
Practice Address - City:NUREMBERG
Practice Address - State:PA
Practice Address - Zip Code:18241-0670
Practice Address - Country:US
Practice Address - Phone:570-704-4235
Practice Address - Fax:570-384-3454
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-05
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007296090014Medicaid
PA1007296090014Medicaid