NPIMap

Organization Active NPI

North Penn Comprehensive Health Services

Doing business as Laurel Pediatrics - Wellsboro

  • Federally Qualified Health Center (FQHC)
  • Wellsboro, PA
National Provider Identifier
1801453980
Registry record updated Nov 16, 2020
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 Pediatrics - Wellsboro
Practice address
1B Main St
Wellsboro, PA 16901-1601
Phone
(570) 724-7100
Fax
(570) 724-1501
NPI assigned
May 23, 2019
Last updated
Nov 16, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTH PENN COMPREHENSIVE HEALTH SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 16, 2020

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

Authorized official

Name
Angela M. Vanzile
Title
Credentialing Coordinator
Phone
(570) 662-1945

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1B Main St
Wellsboro, PA 16901-1601

Mailing address

6A Riverside PLZ
Blossburg, PA 16912-1137
Phone (570) 662-1945

Other names 1

  • Laurel Pediatrics - Wellsboro Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040416000152 PA Part B Supplier - Clinic/Group Practice 0446245880 Receives reassigned benefits from 67 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mansfield, PA; Westfield, PA; Wellsboro, PA; Troy, PA; Towanda, PA; Blossburg, PA; Elkland, PA; Lawrenceville, PA…

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Part of
North Penn Comp Health

Locations

45 Mud Creek Rd
Troy, PA 16947
Phone (570) 297-3746

Practitioners & affiliated clinicians

Practitioners 7

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": "1558569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605484800000",
    "number": "1801453980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6A RIVERSIDE PLZ",
            "city": "BLOSSBURG",
            "state": "PA",
            "postal_code": "169121137",
            "telephone_number": "570-662-1945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1B MAIN ST",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "169011601",
            "telephone_number": "570-724-7100",
            "fax_number": "570-724-1501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH PENN COMPREHENSIVE HEALTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH PENN COMPREHENSIVE HEALTH SERVICES",
        "enumeration_date": "2019-05-23",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A",
        "authorized_official_last_name": "VANZILE",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "570-662-1945"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "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 Pediatrics - Wellsboro",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Laurel Pediatrics - Wellsboro",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wellsboro, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2020; 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.