NPIMap

Organization Active NPI

North Penn Comprehensive Health Services

Doing business as Laurel Dental - Towanda at Progress Plaza

  • Federally Qualified Health Center (FQHC)
  • Towanda, PA
National Provider Identifier
1639928419
Registry record updated May 15, 2024
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
Laurel Dental - Towanda at Progress Plaza
Practice address
1 Elizabeth St Ste 6
Towanda, PA 18848-1629
Phone
(570) 265-2069
NPI assigned
May 15, 2024
Last updated
May 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2024

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

Authorized official

Name
Ronald Meryl Gilbert
Title
Chief Financial Officer
Phone
(570) 828-3869

Specialties & licenses 1

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

Addresses

Primary practice location

1 Elizabeth St Ste 6
Towanda, PA 18848-1629

Mailing address

40 W Wellsboro St
Mansfield, PA 16933-1411
Phone (570) 662-1945

Other names 1

  • Laurel Dental - Towanda at Progress Plaza Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240711002110 PA Part A Provider - Federally Qualified Health Center (FQHC) 0446245880 Practice locations: Towanda, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639928419. Details of each certification follow.

Federally qualified health center certification: CCN D31008

Legal name
NORTH PENN COMPREHENSIVE HEALTH SERVICES
Doing business as
LAUREL DENTAL - TOWANDA AT PROGRESS PLAZA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 1, 2024
Last certification
Jul 1, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 10, 1972 in PA
Enrollment address
1 Elizabeth St
Ste 6
Towanda, PA 18848-1629

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

National Provider Directory

National Provider Directory
Tax ID family
North Penn Comp Health14 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

Locations

40 W Wellsboro St
Mansfield, PA 16933
Phone (570) 662-1945

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Scott D Myers Individual Corporate DirectorBoard Member Apr 1, 2025
John Dennis Murray Individual Corporate DirectorBoard Member Jul 1, 1986
Donna R Wilson Individual Corporate DirectorBoard Member - Secretary Jun 1, 2013
Sean Sember Individual Corporate DirectorBoard Member Sep 22, 2021
James a Nobles Individual Corporate OfficerCeo Mar 5, 2018
W-2 Managing EmployeeCeo Mar 5, 2018
Thomas Thompson Individual Corporate DirectorBoard Member - Treasurer Jul 1, 2022
Jody Thomas Individual Corporate DirectorBoard Member - Vice Chairperson Jul 1, 2019
Megan Wells-Williams Individual Corporate DirectorBoard Member Jul 7, 2021
Kelly Irwin Individual Corporate DirectorBoard Member Jul 1, 2023
Ronald M Gilbert Individual W-2 Managing EmployeeChief Financial Officer May 29, 2018
Kimberly Johns Individual Corporate DirectorBoard Member Jun 29, 2022
Kristopher Kaufman Individual Corporate DirectorBoard Member Jul 1, 2022
Darla Bortz Individual Corporate DirectorBoard Member Apr 1, 2025
Jason Krise Individual Corporate DirectorBoard Member - Chairman Jul 1, 2021

NPI Registry JSON

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

{
    "created_epoch": "1715731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715731200000",
    "number": "1639928419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 W WELLSBORO ST",
            "city": "MANSFIELD",
            "state": "PA",
            "postal_code": "169331411",
            "telephone_number": "570-662-1945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 ELIZABETH ST STE 6",
            "city": "TOWANDA",
            "state": "PA",
            "postal_code": "188481629",
            "telephone_number": "570-265-2069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH PENN COMPREHENSIVE HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-15",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A",
        "authorized_official_last_name": "GILBERT",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "MERYL",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "570-828-3869"
    },
    "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": "Laurel Dental - Towanda at Progress Plaza",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Towanda, PA

Sources for this page

Verify at the official NPI Registry.