NPIMap

Organization Active NPI

Lehigh Valley Hospital Pocono

  • Community/Retail Pharmacy
  • Dickson City, PA
National Provider Identifier
1104561091
Registry record updated Oct 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
LEHIGH VALLEY HOSPITAL POCONO
Practice address
330 Main St
Dickson City, PA 18519-1691
Phone
(570) 330-5180
Fax
(570) 330-5024
NPI assigned
May 4, 2022
Last updated
Oct 1, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
LEHIGH VALLEY HOSPITAL POCONOAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 1, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert Thomas
Title
Chief Accounting Officer
Phone
(484) 884-0901

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary
Institutional Pharmacy 3336I0012X

Addresses

Primary practice location

330 Main St
Dickson City, PA 18519-1691

Mailing address

330 Main St
Dickson City, PA 18519-1691
Phone (570) 330-5180

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240703000164 PA Part B Supplier - Pharmacy 8224934773 Practice locations: Dickson City, PA

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Pocono Medical Center28 organizations share this tax ID, including this one
Part of
Pocono Medical Center

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759276800000",
    "number": "1104561091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 MAIN ST",
            "city": "DICKSON CITY",
            "state": "PA",
            "postal_code": "185191691",
            "telephone_number": "570-330-5180",
            "fax_number": "570-330-5024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 MAIN ST",
            "city": "DICKSON CITY",
            "state": "PA",
            "postal_code": "185191691",
            "telephone_number": "570-330-5180",
            "fax_number": "570-330-5024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEHIGH VALLEY HOSPITAL POCONO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEHIGH VALLEY HOSPITAL POCONO",
        "enumeration_date": "2022-05-04",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "484-884-0901"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dickson City, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.