Provider Demographics
NPI:1790887057
Name:RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
Entity Type:Organization
Organization Name:RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
Other - Org Name:SHICKSHINNY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:ISKRA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:570-825-8741
Mailing Address - Street 1:276 E END CTR
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6970
Mailing Address - Country:US
Mailing Address - Phone:570-825-8741
Mailing Address - Fax:570-825-8990
Practice Address - Street 1:26 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHICKSHINNY
Practice Address - State:PA
Practice Address - Zip Code:18655-1302
Practice Address - Country:US
Practice Address - Phone:570-704-4230
Practice Address - Fax:570-542-2580
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-05
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007296090012Medicaid
PA1007296090012Medicaid