Geisinger Clinic
Organization Active NPI Pediatrics Physician · State College, PA
NPI 1548212970 · NPPES record last updated Jun 27, 2008
Key facts
- NPI
- 1548212970
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- GEISINGER CLINIC
- Practice address
- 2520 Green Tech Drive
Ste D
State College, PA 16803 - Phone
- (814) 235-3300
- NPI assigned
- May 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Kenneth Holdren
- Title
- Cao
- Phone
- (570) 271-5490
Corporate family (same tax ID) 24
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040130000518 | PA | Part B Supplier - Clinic/Group Practice | 5395657001 |
Receives reassigned benefits from 5,323 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Geisinger Clinic Sunbury
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes | ||
| Clinical Medical Laboratory | 291U00000X | PA | ||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
2520 Green Tech Drive
Ste D
State College, PA 16803
Mailing address
100 N Academy Ave
Danville, PA 17822-3034
Other providers in State College, PA
- Geisinger Clinic
- Geisinger Clinic
- Geisinger Clinic
- Geisinger Clinic
- Geisinger Clinic
- Geisinger Clinic
- Geisinger Clinic
- Geisinger Clinic
- Geisinger Clinic
- Geisinger Clinic
All providers in State College, PA · Pediatrics Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.