Provider Demographics
NPI:1679544118
Name:COMMUNITY MEDICAL CENTER
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL CENTER
Other - Org Name:CRNA
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:Z
Authorized Official - Last Name:PERIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-558-3500
Mailing Address - Street 1:PO BOX 934
Mailing Address - Street 2:1822 MULBERRY STREET
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18501-0934
Mailing Address - Country:US
Mailing Address - Phone:570-558-3500
Mailing Address - Fax:570-558-3513
Practice Address - Street 1:1822 MULBERRY STREET
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18501-0934
Practice Address - Country:US
Practice Address - Phone:570-558-3500
Practice Address - Fax:570-558-3513
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-01
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007456760028Medicaid
PA390001Medicare UPIN