Provider Demographics
NPI: | 1245246644 |
---|---|
Name: | GUTHRIE MEDICAL GROUP, P.C. |
Entity Type: | Organization |
Organization Name: | GUTHRIE MEDICAL GROUP, P.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JOSEPH |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | SCOPELLITI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 570-888-5858 |
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: | 570-888-5858 |
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: | 570-888-5858 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-31 |
Last Update Date: | 2015-11-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207LC0200X | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine | Group - Multi-Specialty |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | CC9269 | Other | RR MEDICARE GROUP |
NY | BA1155 | Other | NY MEDICARE CORNING LAB |
NY | CC8362 | Other | RR MEDICARE GROUP |
NY | 02079481 | Medicaid | |
PA | 1007332090087 | Medicaid | |
NY | AA0598 | Medicare ID - Type Unspecified | NY MEDICARE |