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
401 ADAMS AVE, SUITE 201, SCRANTON, PA 18510-2025
(570) 346-7338
(570) 341-3025
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
—
—
207VM0101X
Maternal & Fetal Medicine Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007712910035
—
PA
01
—
1615649
BLUE SHIELD
PA
Enumeration date
05/14/2008
Last updated
10/31/2011
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