Provider Demographics
NPI:1891787800
Name:ANGELINE ELIZABETH KIRBY MEMORIAL HEALTH CENTER
Entity Type:Organization
Organization Name:ANGELINE ELIZABETH KIRBY MEMORIAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-822-4278
Mailing Address - Street 1:71 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-1312
Mailing Address - Country:US
Mailing Address - Phone:570-822-4278
Mailing Address - Fax:570-825-9926
Practice Address - Street 1:71 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-1312
Practice Address - Country:US
Practice Address - Phone:570-822-4278
Practice Address - Fax:570-825-9926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA39D0657582291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007139380001Medicaid
PA0007139380001Medicaid