Provider Demographics
NPI:1518505098
Name:FEDERAL CORRECTIONAL COMPLEX
Entity Type:Organization
Organization Name:FEDERAL CORRECTIONAL COMPLEX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICES ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:POTOPE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:570-547-7950
Mailing Address - Street 1:P.O. BOX 3500
Mailing Address - Street 2:ATTN: HEALTH SERVICES
Mailing Address - City:WHITE DEER
Mailing Address - State:PA
Mailing Address - Zip Code:17887
Mailing Address - Country:US
Mailing Address - Phone:570-547-0963
Mailing Address - Fax:570-547-9294
Practice Address - Street 1:ROUTE 15.2 MI N. OF ALLENWOOD
Practice Address - Street 2:
Practice Address - City:ALLENWOOD
Practice Address - State:PA
Practice Address - Zip Code:17810
Practice Address - Country:US
Practice Address - Phone:570-547-0963
Practice Address - Fax:570-547-9294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABL3346512OtherDEA LICENSE