Organization
SCRANTON CARDIOVASCULAR PHYSICIAN SERVICES 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
743 JEFFERSON AVE STE 305, SCRANTON, PA 18510-1639
(570) 342-1776
(570) 207-1910
Mailing address
4000 MERIDIAN BLVD, FRANKLIN, TN 37067-6325
(615) 465-7000
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102687606-0001
—
PA
01
—
237294
MEDICARE
—
Enumeration date
09/26/2011
Last updated
01/26/2022
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