Provider Demographics
NPI:1154500528
Name:ROBERT PACKER HOSPITAL
Entity Type:Organization
Organization Name:ROBERT PACKER HOSPITAL
Other - Org Name:ROBERT PACKER HOSPITAL EMERGENCY DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:VP CFO FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MACAFEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-887-5985
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-6666
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-6666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT PACKER HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-01
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02213463Medicaid
NY02213463Medicaid