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 2A, SCRANTON, PA 18510-1739
(570) 961-0851
(570) 344-4285
Mailing address
1401 ELECTRIC ST, DUNMORE, PA 18509-2098
(570) 969-9005
(570) 207-0706
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
207VG0400X
Gynecology Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007712910036
—
PA
01
—
763807
BLUE SHIELD
PA
Enumeration date
05/14/2008
Last updated
11/01/2011
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