Provider Demographics
NPI:1366444507
Name:COMMUNITY MEDICAL CENTER
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL CENTER
Other - Org Name:GEISINGER COMMUNITY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR CREDENTIALING/ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-271-6603
Mailing Address - Street 1:1800 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-2369
Mailing Address - Country:US
Mailing Address - Phone:570-969-8900
Mailing Address - Fax:570-969-8814
Practice Address - Street 1:1800 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2369
Practice Address - Country:US
Practice Address - Phone:570-969-8900
Practice Address - Fax:570-969-8814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA037101282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA074005OtherFIRST PRIORITY HEALTH
PA1007456760005Medicaid
PA1007456760024Medicaid
PA1007456760006Medicaid
PA107456760020Medicaid
PA1007456760005Medicaid
PA39S001Medicare ID - Type Unspecified
PA107456760020Medicaid