NPIMap

Organization Active NPI

Robert Packer Hospital

  • Community/Retail Pharmacy
  • Sayre, PA
National Provider Identifier
1104847169
Registry record updated Nov 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PP413232L Issued in PA
Legal business name
ROBERT PACKER HOSPITAL
Practice address
1 Guthrie SQ
Suite Ec101
Sayre, PA 18840-1625
Phone
(570) 887-2800
Fax
(570) 887-2827
NPI assigned
Jul 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2015

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

Authorized official

Name
Jennifer Shay
Title
Operations Manager
Phone
(570) 887-2816

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PP413232L PA Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

1 Guthrie SQ
Suite Ec101
Sayre, PA 18840-1625

Mailing address

1 Guthrie SQ
Suite Ec101
Sayre, PA 18840-1625
Phone (570) 887-2800

Other identifiers 3

IdentifierTypeStateIssuer
1161970002OtherPAMEDICARE PTAN
1007706140042MedicaidPA
2082808OtherPK

Other names 1

  • CLINIC PHARMACY Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930029482 PA DME Supplier - Pharmacy 8022915180 Practice locations: Sayre, 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
Packer Hospital Rob11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

1 Guthrie Sq
Ste EC101
Sayre, PA 18840
Phone (570) 887-2800

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447891200000",
    "number": "1104847169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GUTHRIE SQ",
            "address_2": "SUITE EC101",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401625",
            "telephone_number": "570-887-2800",
            "fax_number": "570-887-2827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GUTHRIE SQ",
            "address_2": "SUITE EC101",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401625",
            "telephone_number": "570-887-2800",
            "fax_number": "570-887-2827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT PACKER HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2015-11-19",
        "status": "A",
        "authorized_official_last_name": "SHAY",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "570-887-2816"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP413232L",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "1161970002",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007706140042",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2082808",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CLINIC PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sayre, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2015; 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.