Organization
WILKES-BARRE CLINIC COMPANY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SENIOR DIRECTOR PROVIDER ENROLLMENT)
(877) 892-9815
Entity
Organization
Contact information
Practice address
575 N RIVER ST, WILKES BARRE, PA 18702-2634
(570) 552-1300
(570) 552-1498
Mailing address
4000 MERIDIAN BLVD, FRANKLIN, TN 37067-6325
(615) 465-7000
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
—
PA
208600000X
Surgery Physician
Primary
—
—
2086X0206X
Surgical Oncology Physician
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102514239
—
PA
Enumeration date
07/26/2010
Last updated
01/25/2022
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