Provider Demographics
NPI:1326116583
Name:PATIENT CARE CORPORATION
Entity Type:Organization
Organization Name:PATIENT CARE CORPORATION
Other - Org Name:PATIENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WASSEROTT
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:570-283-0691
Mailing Address - Street 1:515 517 MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4535
Mailing Address - Country:US
Mailing Address - Phone:570-283-0691
Mailing Address - Fax:570-283-4836
Practice Address - Street 1:515 517 MARKET STREET
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-4535
Practice Address - Country:US
Practice Address - Phone:570-283-0691
Practice Address - Fax:570-283-4836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA282122OtherBLUE CROSS BLUE SHIELD
PAP025384OtherTRICARE
PA0005693700001Medicaid
PA0424160001Medicare ID - Type Unspecified