Organization
GEISINGER SOUTH WILKES BARRE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH HOLDREN (CAO)
(570) 271-5490
Entity
Organization
Contact information
Practice address
25 CHURCH ST, WILKES BARRE, PA 18765
(570) 826-3293
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-3034
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
05/12/2006
Last updated
06/30/2008
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