NPIMap

Organization Active NPI

Delta Medix PC

  • Legal Medicine
  • Scranton, PA
National Provider Identifier
1396701876
Registry record updated Jan 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Legal MedicineTaxonomy code 173000000X
Legal business name
DELTA MEDIX PC
Practice address
300 Lackawanna Ave
Scranton, PA 18503-2001
Phone
(570) 342-7864
Fax
(570) 207-7678
NPI assigned
Apr 25, 2006
Last updated
Jan 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2019

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

Authorized official

Name
Mrs. Theresa Demyan, CPA
Title
Accountant
Phone
(570) 558-3565

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Legal Medicine 173000000X NU Primary

Addresses

Primary practice location

300 Lackawanna Ave
Scranton, PA 18503-2001

Mailing address

300 Lackawanna Ave
Scranton, PA 18503-2001
Phone (570) 558-3565

Other practice location 1

5 Morgan Hwy Ste 7
Scranton, PA 18508-2641
Phone (570) 445-2422

Other identifiers 1

IdentifierTypeStateIssuer
000715941MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040325001062 PA Part B Supplier - Clinic/Group Practice 0648162636 Receives reassigned benefits from 60 practitioners
Practice locations: Churchville, PA; Scranton, PA

National Provider Directory

National Provider Directory

Locations

236 Penn Ave
Scranton, PA 18503
Phone (570) 969-0100

300 Lackawanna Ave
Unit 200
Scranton, PA 18503
Phone (570) 342-7864

677 Roosevelt Hwy
#100
Waymart, PA 18472
Phone (570) 488-9600

Practitioners & affiliated clinicians

Practitioners 68

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 68

NPI Registry JSON

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548374400000",
    "number": "1396701876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 LACKAWANNA AVE",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185032001",
            "telephone_number": "570-558-3565",
            "fax_number": "570-207-7678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LACKAWANNA AVE",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185032001",
            "telephone_number": "570-342-7864",
            "fax_number": "570-207-7678"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5 Morgan Hwy Ste 7",
            "address_purpose": "LOCATION",
            "city": "Scranton",
            "state": "PA",
            "postal_code": "185082641",
            "country_code": "US",
            "telephone_number": "570-445-2422",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DELTA MEDIX PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2019-01-25",
        "status": "A",
        "authorized_official_last_name": "DEMYAN",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "ACCOUNTANT",
        "authorized_official_telephone_number": "570-558-3565",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000715941",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Scranton, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2019; 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.