Organization
PHYSICIANS HEALTH ALLIANCE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA KANE (COO)
(570) 969-9005
Entity
Organization
Contact information
Practice address
748 QUINCY AVE, 1A, SCRANTON, PA 18510-1739
(570) 342-5253
(570) 342-6038
Mailing address
1401 ELECTRIC ST, DUNMORE, PA 18509-2098
(570) 969-9005
(570) 207-0706
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007712910043
—
PA
01
—
2563602
BLUE SHIELD
PA
Enumeration date
11/23/2010
Last updated
10/31/2011
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