Organization
HAZLETON PROFESSIONAL SERVICES
Active
Organization
HAZLETON PROFESSIONAL SERVICES
Active
Parent organization
GREATER HAZLETON HEALTH ALLIANCE
Other names
Lehigh Valley Physician Group-Hazleton
Organization subpart
Yes
Provider details
NPI number
Legal business name
GREATER HAZLETON HEALTH ALLIANCE
Authorized official
JAMES DEMOPOULOS (SR VP & COO)
(484) 884-4500
Entity
Organization
Contact information
Practice address
700 EAST BROAD STREET, HAZLETON, PA 18201-6835
(570) 501-4584
(570) 501-4754
Mailing address
PO BOX 1830, ALLENTOWN, PA 18105-1830
(570) 501-6368
(570) 501-4754
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208600000X
Surgery Physician
—
—
213E00000X
Podiatrist
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1019653980001
—
PA
01
—
1954699
HIGHMARK BLUE SHIELD
PA
Enumeration date
12/18/2006
Last updated
05/11/2022
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