Provider Demographics
NPI:1851555403
Name:PHYSICIANS HEALTH ALLIANCE INC
Entity Type:Organization
Organization Name:PHYSICIANS HEALTH ALLIANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-969-9005
Mailing Address - Street 1:1401 ELECTRIC ST
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18509-2098
Mailing Address - Country:US
Mailing Address - Phone:570-969-9005
Mailing Address - Fax:570-207-0706
Practice Address - Street 1:748 QUINCY AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1739
Practice Address - Country:US
Practice Address - Phone:570-347-9600
Practice Address - Fax:570-342-0681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004844L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1632776OtherBLUE SHIELD
PA1007712910041Medicaid
PA3939320001Medicare NSC
PA1007712910041Medicaid