NPIMap

Organization Active NPI

Pennsylvania Care, LLC

Doing business as Miners Medical

  • Methadone Clinic
  • Ashley, PA
National Provider Identifier
1467759399
Registry record updated Jul 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
License
407058 Issued in PA
Legal business name
PENNSYLVANIA CARE, LLC
Doing business as
Miners Medical
Practice address
43 S Main St
Ashley, PA 18706-1506
Phone
(570) 822-5145
Fax
(570) 822-5147
NPI assigned
Feb 11, 2011
Last updated
Jul 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2022

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

Authorized official

Name
Robyn Tanis
Title
Executive Director of Contract MGMT
Phone
(856) 533-8762

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X 407058 PA Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

43 S Main St
Ashley, PA 18706-1506

Mailing address

1317 Route 73 Ste 200
Mount Laurel, NJ 08054-2202
Phone (856) 429-6111

Other practice location 1

90 E Union St Ste 3
Wilkes Barre, PA 18701-3210
Phone (570) 822-5145

Other names 1

  • Miners Medical Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Opioid treatment program
Medicare-enrolled since Jan 1, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200514000507 PA Part B Supplier - Opioid Treatment Program (Otp) 8729419361 Practice locations: Wilkes Barre, PA

National Provider Directory

National Provider Directory

Locations

43 S Main St
Ashley, PA 18706
Phone (570) 822-5145

43 S Main St
#2
Ashley, PA 18706
Phone (570) 822-5145

90 E Union St
Ste 3
Wilkes Barre, PA 18701
Phone (570) 822-5145

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1297382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658102400000",
    "number": "1467759399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 ROUTE 73 STE 200",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080542202",
            "telephone_number": "856-429-6111",
            "fax_number": "570-822-5147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 S MAIN ST",
            "city": "ASHLEY",
            "state": "PA",
            "postal_code": "187061506",
            "telephone_number": "570-822-5145",
            "fax_number": "570-822-5147"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "90 E Union St Ste 3",
            "address_purpose": "LOCATION",
            "city": "Wilkes Barre",
            "state": "PA",
            "postal_code": "187013210",
            "country_code": "US",
            "telephone_number": "570-822-5145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PENNSYLVANIA CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-11",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A",
        "authorized_official_last_name": "TANIS",
        "authorized_official_first_name": "ROBYN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR OF CONTRACT MGMT",
        "authorized_official_telephone_number": "856-533-8762"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "PA",
            "license": "407058",
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Miners Medical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Miners Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ashley, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; 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.