Provider Demographics
NPI:1679115760
Name:RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
Entity type:Organization
Organization Name:RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:ISKRA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:570-825-8741
Mailing Address - Street 1:276 E END CTR
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6970
Mailing Address - Country:US
Mailing Address - Phone:570-825-8741
Mailing Address - Fax:570-825-8990
Practice Address - Street 1:1730 E BROAD ST STE 2
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-5657
Practice Address - Country:US
Practice Address - Phone:570-455-9589
Practice Address - Fax:570-455-8848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-10
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty