NPIMap

Organization Active NPI

Children's Service Center of Wyoming Valley, Inc

  • Federally Qualified Health Center (FQHC)
  • Wilkes Barre, PA
National Provider Identifier
1710617857
Registry record updated Aug 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHILDREN'S SERVICE CENTER OF WYOMING VALLEY, INC
Practice address
335 S Franklin St BLDG a
Wilkes Barre, PA 18702-3808
Phone
(570) 301-0924
NPI assigned
Jun 13, 2022
Last updated
Aug 12, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
CHILDREN'S SERVICE CENTER OF WYOMING VALLEY INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 12, 2026

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

Authorized official

Name
Sharon Vivian
Title
Cfo
Phone
(570) 825-6425

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X
Pediatrics Physician 208000000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

335 S Franklin St BLDG a
Wilkes Barre, PA 18702-3808

Mailing address

335 S Franklin St
Wilkes Barre, PA 18702-3808
Phone (570) 825-6425

Other identifiers 1

IdentifierTypeStateIssuer
1007280110160MedicaidPA

Other names 1

  • Conyngham Primary Health Care Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170609001473 PA Part B Supplier - Clinic/Group Practice 1052567617 Receives reassigned benefits from 51 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Honesdale, PA; Tunkhannock, PA; Wilkes Barre, PA
O20250723001645 PA Part A Provider - Federally Qualified Health Center (FQHC) 1052567617 Practice locations: Wilkes Barre, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710617857. Details of each certification follow.

Federally qualified health center certification: CCN D31039

Legal name
CHILDREN'S SERVICE CENTER OF WYOMING VALLEY INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 17, 2025
Last certification
Jul 17, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
335 S Franklin St
Wilkes Barre, PA 18702-3808

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D2269272Conyngham Primary Health Care Center335 South Franklin Street, Wilkes-Barre, PA 18702Certificate of waiverSep 22, 2026

National Provider Directory

National Provider Directory
Tax ID family
Children's Service Center of Wyoming Valley13 organizations share this tax ID, including this one
Part of
Children's Service Center of Wyoming Valley

Other organizations with this tax ID 12

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

Locations

334 S Franklin St
Wilkes Barre, PA 18702
Phone (570) 301-0935

335 S Franklin St
Bldg A
Wilkes Barre, PA 18702
Phone (570) 301-0924

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Children's Service Center of Wyoming Valley Inc Organization, Wilkes Barre, PA Non-profit Operational/Managerial Control Jul 1, 2025
Joel Smith Individual W-2 Managing EmployeeCio Feb 2, 2009 100%
Colleen Doyle Individual Corporate OfficerPresident Dec 4, 2023
Edward Coleman Individual Corporate OfficerTreasurer Nov 25, 2024
Matthew Shaffer Individual Corporate Officer Nov 25, 2024
John Henry Individual Corporate OfficerSecretary Nov 25, 2024
Sharon Kaye Pisarcik Individual W-2 Managing EmployeeCfo Jan 30, 2017 100%
Christopher Boyle Individual W-2 Managing EmployeeCeo May 12, 2008 100%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 52

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 52

NPI Registry JSON

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

{
    "created_epoch": "1655078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786492800000",
    "number": "1710617857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 S FRANKLIN ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187023808",
            "telephone_number": "570-825-6425",
            "fax_number": "570-762-9013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 S FRANKLIN ST BLDG A",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187023808",
            "telephone_number": "570-301-0924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S SERVICE CENTER OF WYOMING VALLEY, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDREN'S SERVICE CENTER OF WYOMING VALLEY INC",
        "enumeration_date": "2022-06-13",
        "last_updated": "2026-08-12",
        "certification_date": "2026-08-12",
        "status": "A",
        "authorized_official_last_name": "VIVIAN",
        "authorized_official_first_name": "SHARON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "570-825-6425"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007280110160",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Conyngham Primary Health Care Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wilkes Barre, PA

Sources for this page

Verify at the official NPI Registry.