NPIMap

Organization Active NPI

North Penn Comprehensive Health Services

  • Federally Qualified Health Center (FQHC)
  • Wellsboro, PA
National Provider Identifier
1043392020
Registry record updated Dec 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTH PENN COMPREHENSIVE HEALTH SERVICES
Practice address
103 West Ave
Wellsboro Laurel Health Center
Wellsboro, PA 16901-1358
Phone
(570) 724-1010
Fax
(570) 724-3970
NPI assigned
Oct 19, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Ronald Meryl Gilbert Jr.
Title
Cfo
Phone
(570) 662-1955

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040416000152 PA Part B Supplier - Clinic/Group Practice 0446245880 Receives reassigned benefits from 67 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mansfield, PA; Westfield, PA; Wellsboro, PA; Troy, PA; Towanda, PA; Blossburg, PA; Elkland, PA; Lawrenceville, PA…
O20050517000215 PA Part a Provider - Federally Qualified Health Center (FQHC) 0446245880 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wellsboro, PA

Federally qualified health center certification: CCN 391848

Medicare enrollment files
Legal name
NORTH PENN COMPREHENSIVE HEALTH SERVICES
Doing business as
WELLSBORO LAUREL HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Aug 10, 1972 in PA
Enrollment address
7 Water St
Wellsboro, PA 16901-1126

All disclosed owners & managing parties 15

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
John Dennis Murray Individual Corporate DirectorBoard Member May 18, 1989 100%
Matthew S Decamp Individual Corporate DirectorBoard Member Jul 1, 2018 100%
Lisa V Feil Individual Corporate DirectorBoard Member Jul 1, 2013 100%
Donna R Wilson Individual Corporate DirectorBoard Member Jul 1, 1998 100%
Robert F Fitzgerald Individual Corporate DirectorBoard Member Jul 1, 1994 100%
Kathy J Wright Individual Corporate DirectorBoard Member Jul 1, 2012 100%
Jill a Burns Individual Corporate DirectorBoard Member Jul 1, 2015 100%
James a Nobles Individual Corporate DirectorPresident/Ceo Mar 5, 2018 100%
W-2 Managing Employee Mar 5, 2018 100%
Darius E Abadi Individual Corporate DirectorBoard Member Jan 31, 2019 100%
Michael W Lichty Individual Corporate DirectorBoard Member Jul 1, 2004 100%
Harold F Hoose Individual Corporate DirectorBoard Member Jul 1, 2012 100%
Steven P Johnson Individual Corporate DirectorBoard Member Jul 1, 2016 100%
Wendy S Swartz Individual Corporate DirectorBoard Member Jul 1, 2013 100%
Ronald M Gilbert Individual Corporate OfficerVP/Cfo Aug 14, 2015
Corporate DirectorVP/Cfo Aug 14, 2015
W-2 Managing Employee Apr 18, 2019
Operational/Managerial Control Apr 18, 2019
Glenn B Poirier Individual Corporate DirectorPresident of the Board Jan 24, 2006 100%

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

NPPES NPI Registry

Primary practice location

103 West Ave
Wellsboro Laurel Health Center
Wellsboro, PA 16901-1358

Mailing address

7 Water St
Wellsboro, PA 16901-1126
Phone (570) 662-1955

Other names 1

NPPES NPI Registry
  • Laurel Health Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 6, 2018.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544054400000",
    "number": "1043392020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 WATER ST",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "169011126",
            "telephone_number": "570-662-1955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 WEST AVE",
            "address_2": "WELLSBORO LAUREL HEALTH CENTER",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "169011358",
            "telephone_number": "570-724-1010",
            "fax_number": "570-724-3970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH PENN COMPREHENSIVE HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2018-12-06",
        "status": "A",
        "authorized_official_last_name": "GILBERT",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "MERYL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "570-662-1955",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laurel Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Laurel Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wellsboro, PA

Sources for this page

Verify at the official NPI Registry.