Provider Demographics
NPI:1356463483
Name:JAMES WEI-TZER HU MD PC
Entity Type:Organization
Organization Name:JAMES WEI-TZER HU MD PC
Other - Org Name:JAMES W. T. HU MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W T
Authorized Official - Last Name:HU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-462-3542
Mailing Address - Street 1:239 W CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:PA
Mailing Address - Zip Code:17976-1608
Mailing Address - Country:US
Mailing Address - Phone:570-462-3542
Mailing Address - Fax:570-462-3542
Practice Address - Street 1:239 W. CENTER ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:PA
Practice Address - Zip Code:17976-1608
Practice Address - Country:US
Practice Address - Phone:570-462-3542
Practice Address - Fax:570-462-3542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035065L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006679510002Medicaid
PAC30318Medicare UPIN
PA0006679510002Medicaid