Organization
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Active
Other names
Carbondale Pediatric Center
Organization subpart
No
Provider details
NPI number
Authorized official
FREDERICK JACKSON (EXECUTIVE DIRECTOR)
(570) 253-8450
Entity
Organization
Contact information
Practice address
152 BROOKLYN ST, CARBONDALE, PA 18407-2208
(570) 282-2031
(570) 282-2534
Mailing address
601 PARK ST, HONESDALE, PA 18431-1445
(570) 253-8226
(570) 253-8228
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100773665
—
PA
Enumeration date
11/30/2011
Last updated
11/30/2011
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