Organization
PAIN CENTER OF WYOMING VALLEY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA RICCA (CEO)
(570) 270-5700
Entity
Organization
Contact information
Practice address
142 MUNDY ST, WILKES BARRE, PA 18702-6875
(570) 270-5712
(570) 270-2015
Mailing address
1177 HIGHWAY 315 BLVD, DOLPHIN PLAZA, WILKES BARRE, PA 18702-6928
(570) 270-5712
(570) 270-5719
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
23881501
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1030398800001
—
PA
Enumeration date
12/03/2013
Last updated
05/04/2023
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