NPIMap

Organization Active NPI

Wayne Memorial Community Health Centers

Doing business as Carbondale Pediatric Center

  • Pediatrics Physician
  • Carbondale, PA
National Provider Identifier
1336416619
Registry record updated Nov 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Doing business as
Carbondale Pediatric Center
Practice address
152 Brooklyn St
Carbondale, PA 18407-2208
Phone
(570) 282-2031
Fax
(570) 282-2534
NPI assigned
Nov 30, 2011
Last updated
Nov 30, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2011

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

Authorized official

Name
Frederick Jackson
Title
Executive Director
Phone
(570) 253-8450

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

152 Brooklyn St
Carbondale, PA 18407-2208

Mailing address

601 Park St
Honesdale, PA 18431-1445
Phone (570) 253-8226

Other identifiers 1

IdentifierTypeStateIssuer
100773665MedicaidPA

Other names 1

  • Carbondale Pediatric Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Hamlin Family Health Center27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1322611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322611200000",
    "number": "1336416619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 PARK ST",
            "city": "HONESDALE",
            "state": "PA",
            "postal_code": "184311445",
            "telephone_number": "570-253-8226",
            "fax_number": "570-253-8228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 BROOKLYN ST",
            "city": "CARBONDALE",
            "state": "PA",
            "postal_code": "184072208",
            "telephone_number": "570-282-2031",
            "fax_number": "570-282-2534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE MEMORIAL COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-30",
        "last_updated": "2011-11-30",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "570-253-8450"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100773665",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carbondale Pediatric Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carbondale, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.