NPIMap

Geisinger Wyoming Valley Medical Center

Organization Active NPI Clinic/Center · Wilkes Barre, PA

NPI 1205197894 · NPPES record last updated Jul 2, 2019

Key facts

NPI
1205197894
Entity type
Organization (NPI type 2)
Primary specialty
Clinic/Center 261Q00000X
Legal business name
GEISINGER WYOMING VALLEY MEDICAL CENTER
Practice address
1175 East Mountain Blvd
Wilkes Barre, PA 18702-7906
Phone
(570) 808-1093
Fax
(570) 808-7878
NPI assigned
May 31, 2012
Organization subpart
No

Authorized official

Name
Cindy Mull
Title
Director
Phone
(570) 271-6144

Owners & managing parties with NPI records 1

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

Other NPIs on the same Medicare enrollment 19

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

Other NPIs with the same Medicare PAC ID 4

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

Corporate family (same tax ID) 22

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

Affiliated clinicians 1,567

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

View all 1,567

Medicare Care Compare: Hospital

Listed as
Geisinger Wyoming Valley Medical Center CCN 390270
Overall star rating
★★★★☆ 4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Geisinger Wyoming Valley Medical Ce
1175 E Mountain Blvd, Wilkes Barre, PA 18702-7906 · (570) 808-4779		 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom Does not accept assignment
Participating since Feb 24, 2017

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in PA

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
Corporation · Non-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

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 Officer
Associate Vice President, Finance		 Jan 1, 2026
W-2 Managing Employee Jan 1, 2026
William Schultz
Individual 		Corporate Officer
Vice 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

Medicare enrollment records

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…
O20170502000369 PA DME Supplier - Orthotic Personnel
DME Supplier - Physician Assistant
DME Supplier - Physician - Unknown Physician Specialty
DME Supplier - Physician - Orthopedic/Orthopedic Surgery
DME Supplier - Physician - Podiatry
DME Supplier - Nurse Practitioner
DME Supplier - Sports Medicine		 5092780023 Practice locations: Wilkes Barre, PA

National Provider Directory

Tax ID family
Rad NPW Fund (23 organizations share this tax ID)

Locations

300 Lackawanna Ave
Scranton, PA 18503
Phone (570) 342-7864

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Yes
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1175 East Mountain Blvd
Wilkes Barre, PA 18702-7906

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6211

Other identifiers

IdentifierTypeStateIssuer
7593410001OtherPAMEDICARE DME NUMBER
390270OtherMEDICARE

Other providers in Wilkes Barre, PA

All providers in Wilkes Barre, PA · Clinic/Center in Pennsylvania

Sources for this page

Verify at the official NPI Registry.