Cedar Emergency Physicians Inc
Organization Active NPI Urgent Care Clinic/Center · Hazleton, PA
NPI 1760413595 · NPPES record last updated Aug 26, 2022
Key facts
- NPI
- 1760413595
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Urgent Care Clinic/Center 261QU0200X
- License
- OS007636L (PA)
- Legal business name
- CEDAR EMERGENCY PHYSICIANS INC
- Practice address
- 101 S Church St
Suite B
Hazleton, PA 18201-6279 - Phone
- (570) 501-2692
- Fax
- (570) 501-2695
- NPI assigned
- Jul 6, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Paul J Tayoun, DO
- Title
- President
- Phone
- (570) 501-2692
Practitioners 3
-
Paul J Tayoun, DO
-
Kerry C Willis, CRNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 39D1065516 | Cedar Emergency Physicians Inc | Certificate of waiver | Mar 4, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040204000074 | PA | Part B Supplier - Clinic/Group Practice | 7113810268 |
Receives reassigned benefits from 1 practitioner Practice locations: Hazleton, PA |
National Provider Directory
Locations
101 S Church St
Ste B
Hazleton, PA 18201
Phone (570) 501-1017
57 W Juniper St
Hazleton, PA 18201
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urgent Care Clinic/Center | 261QU0200X | OS007636L | PA | Yes |
| Clinical Medical Laboratory | 291U00000X |
Addresses
Primary practice location
101 S Church St
Suite B
Hazleton, PA 18201-6279
Mailing address
101 S Church St
Suite B
Hazleton, PA 18201-6279
Phone (570) 501-2692
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0019549630004 | Medicaid | PA |
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2022. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.