NPIMap

Organization Active NPI

Geisinger Wyoming Valley Medical Center

  • Clinic/Center
  • Dickson City, PA
National Provider Identifier
1104624246
Registry record updated Jul 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
GEISINGER WYOMING VALLEY MEDICAL CENTER
Practice address
703 Martin F Gibbons Blvd
Dickson City, PA 18519-1787
Phone
(570) 846-2340
Fax
(570) 846-2341
NPI assigned
Mar 5, 2025
Last updated
Jul 24, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2026

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

Authorized official

Name
Will Xenakis
Title
System Director Credentialing
Phone
(516) 661-8959

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary
General Acute Care Hospital 282N00000X NU

Addresses

Primary practice location

703 Martin F Gibbons Blvd
Dickson City, PA 18519-1787

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6144

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040901000618 PA Part A Provider - Hospital 5092780023 21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wilkes Barre, PA; Wilkes-Barre, PA; Wilkes -Barre, PA; Dallas, PA; Dickson City, PA; Forty Fort, PA; Mountain Top, PA; Mountaintop, PA…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104624246. Details of each certification follow.

Hospital certification: CCN 390270

Legal name
GEISINGER WYOMING VALLEY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Apr 20, 1981
Last certification
Sep 4, 2025
Beds
356 (317 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Feb 2, 1976 in PA
Enrollment address
1000 East Mountain Drive
GWV Op Surgery
Wilkes Barre, PA 18711-0027
Other Hospital Practice Location
Hospital subgroups
General, Acute care

Other NPIs on the same Medicare enrollment 19

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

View all 19

Care Compare: Hospital

Medicare Care Compare
Listed as
Geisinger Wyoming Valley Medical CenterCCN 390270 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Geisinger Medic 30324 organizations share this tax ID, including this one

Other organizations with this tax ID 23

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

View all 23

Locations

21 Commerce CT
GWV Mt Pocono Hop
Dallas, PA 18344
Phone (570) 839-3633

42 N Main St
#A
Pittston, PA 18640
Phone (570) 654-0880

1130 Highway 315
Ste 315
Wilkes Barre, PA 18702
Phone (570) 821-2830

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Terry Gilliland Individual Corporate Officer Mar 1, 2025
Daniel J Gaydon Individual Corporate OfficerAssociate Vice President, Finance Jan 1, 2026
W-2 Managing Employee Jan 1, 2026
William Schultz Individual Corporate OfficerVice President & Cfo Jan 1, 2026
W-2 Managing Employee Jan 1, 2026
Jeffrey a Jacobson Individual Corporate Officer Jan 1, 2019
Chris Holcombe Individual Corporate Officer Jan 1, 2017
Benjamin K Chu Individual Corporate Director Jan 1, 2020
Virginia McGregor Individual Corporate Officer Jan 1, 2017
Jason Mitchell Individual Corporate Officer Jan 1, 2026
Megan Brosious Individual Corporate Officer Mar 1, 2025

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 1,567

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 1,567

NPI Registry JSON

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

{
    "created_epoch": "1741132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784851200000",
    "number": "1104624246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-271-6144",
            "fax_number": "570-271-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 MARTIN F GIBBONS BLVD",
            "city": "DICKSON CITY",
            "state": "PA",
            "postal_code": "185191787",
            "telephone_number": "570-846-2340",
            "fax_number": "570-846-2341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEISINGER WYOMING VALLEY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-05",
        "last_updated": "2026-07-24",
        "certification_date": "2026-07-24",
        "status": "A",
        "authorized_official_last_name": "XENAKIS",
        "authorized_official_first_name": "WILL",
        "authorized_official_title_or_position": "SYSTEM DIRECTOR CREDENTIALING",
        "authorized_official_telephone_number": "516-661-8959"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dickson City, PA

Sources for this page

Verify at the official NPI Registry.