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, SUITE 1A, SCRANTON, PA 18510-1739
(570) 347-9600
(570) 342-0681
Mailing address
1401 ELECTRIC ST, DUNMORE, PA 18509-2098
(570) 969-9005
(570) 207-0706
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
SC004844L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007712910041
—
PA
01
—
1632776
BLUE SHIELD
PA
Enumeration date
07/14/2008
Last updated
10/31/2011
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