NPIMap

Organization Active NPI

North Penn Comprehensive Health Services

Doing business as Wellsboro Laurel Health Center

  • Federally Qualified Health Center (FQHC)
  • Wellsboro, PA
National Provider Identifier
1235570417
Registry record updated Nov 16, 2020
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
Doing business as
Wellsboro Laurel Health Center
Practice address
7 Water St
Wellsboro Laurel Health Center
Wellsboro, PA 16901-1126
Phone
(570) 724-1010
Fax
(570) 724-3970
NPI assigned
Jul 16, 2013
Last updated
Nov 16, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2020

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

Authorized official

Name
Angela M. Vanzile
Title
Credentialing Coordinator
Phone
(570) 662-1982

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

7 Water St
Wellsboro Laurel Health Center
Wellsboro, PA 16901-1126

Mailing address

6A Riverside PLZ
Blossburg, PA 16912-1137
Phone (570) 662-1945

Other names 1

  • Wellsboro Laurel Health Center Doing business as

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
Practice locations: Wellsboro, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235570417. Details of each certification follow.

Federally qualified health center certification: CCN 391848

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

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
North Penn Comprehensiv14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All disclosed owners & managing parties 15

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%

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1373932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605484800000",
    "number": "1235570417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6A RIVERSIDE PLZ",
            "city": "BLOSSBURG",
            "state": "PA",
            "postal_code": "169121137",
            "telephone_number": "570-662-1945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 WATER ST",
            "address_2": "WELLSBORO LAUREL HEALTH CENTER",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "169011126",
            "telephone_number": "570-724-1010",
            "fax_number": "570-724-3970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH PENN COMPREHENSIVE HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-16",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A",
        "authorized_official_last_name": "VANZILE",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "570-662-1982"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellsboro Laurel Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wellsboro, PA

Sources for this page

Verify at the official NPI Registry.