Scranton Primary Health Care Center, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Scranton, PA
NPI 1841709623 · NPPES record last updated Oct 1, 2020
Key facts
- NPI
- 1841709623
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SCRANTON PRIMARY HEALTH CARE CENTER, INC
- Practice address
- 406 N Washington Ave
Scranton, PA 18503-1306 - Phone
- (570) 344-9684
- NPI assigned
- Sep 25, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- SCRANTON PRIMARY HEALTH CARE CENTER, INC
Authorized official
- Name
- Mr. Joseph H Hollander
- Title
- Ceo
- Phone
- (570) 344-3517
Parent organization (reported in NPPES) 1
Other NPIs on the same Medicare enrollment 2
Practitioners 29
-
Aiman Aslam, DMD
-
Kimberly A Barilla, CRNP
-
Lisa Black-Lafferty, LCSW
-
Christine Burke, M.D.
-
Ryan Carl Dell'Aglio, D.M.D
-
Krysten Duliba, CRNP
-
Anjalika Gupta, MD
-
John McGuire, D.M.D.
-
Wasique Mirza, MD
-
Dana Marie Montgomery, D.O.
-
Heidi Alyssa Mosher, MSN, WHNP
-
Kari Ann Myder, CRNP
-
Elaine Theresa Richards-Hercher, RN / CNM
-
Evan Morgan Rider, DMD
-
Robert Michael Riley, DMD
-
Amy M. Schoonover, CRNP
-
Ashley Nichole Schrader, CRNP
-
Elise Marie Stavish, DNP, CRNP, FNP-C
-
Maria J. Tacelosky, D.M.D.
-
Carole L. Willson, CRNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 39D2239966 | Scranton Primary Health Care Center Inc | Certificate of waiver | Oct 14, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061019000363 | PA | Part B Supplier - Clinic/Group Practice | 0941206650 |
Receives reassigned benefits from 30 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Scranton, PA |
National Provider Directory
- Part of
- Green Ridge Primary Car
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
406 N Washington Ave
Scranton, PA 18503-1306
Mailing address
959 Wyoming Ave
Scranton, PA 18509-3023
Phone (570) 344-3517
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1007288710010 | Medicaid | PA |
Other providers in Scranton, PA
- Scranton Hospital Company LLC
- Scranton Hospital Company LLC
- Scranton Hospitalist Physician Services LLC
- Scranton Neurological Associates PC
- Scranton Pharmacy Inc
- Scranton Primary Health Care Center, Inc.
- Scranton Primary Health Care Center, Inc.
- Scranton Quincy Ambulance LLC
- Scranton Quincy Clinic Company LLC
- Scranton Quincy Clinic Company LLC
All providers in Scranton, PA · Federally Qualified Health Center (FQHC) in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2020. 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.