Provider Demographics
NPI:1558549006
Name:WILKES BARRE VETERAN'S HOSPITAL
Entity Type:Organization
Organization Name:WILKES BARRE VETERAN'S HOSPITAL
Other - Org Name:VAMC
Other - Org Type:Other Name
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOETCHIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-824-3521
Mailing Address - Street 1:538 WARREN AVENUE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 EAST END BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702
Practice Address - Country:US
Practice Address - Phone:570-824-3521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN300300282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital