Organization
GEISINGER CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH HOLDREN (CAO)
(570) 271-5490
Entity
Organization
Contact information
Practice address
12 KIRBY AVE, MOUNTAIN TOP, PA 18707-1215
(570) 474-5980
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-3034
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
710347
HIGHMARK BS
PA
Enumeration date
09/25/2006
Last updated
06/30/2008
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