Organization
RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
Active
Parent organization
RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
Other names
BLACK CREEK HEALTH CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
Authorized official
EDWARD MCCARTHY (CHIEF FINANCIAL OFFICER)
(570) 825-8741
Entity
Organization
Contact information
Practice address
75 PINEAPPLE STREET, NUREMBERG, PA 18241-0670
(570) 704-4235
(570) 384-3454
Mailing address
1084 ROUTE 315, WILKES-BARRE, PA 18702-7012
(570) 825-8741
(570) 825-8990
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007296090014
—
PA
Enumeration date
09/05/2006
Last updated
03/06/2020
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