Provider Demographics
NPI:1891867255
Name:SHAMOKIN DAM HEALTH CENTER
Entity Type:Organization
Organization Name:SHAMOKIN DAM HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-743-4333
Mailing Address - Street 1:3166 N OLD TRAIL
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN DAM
Mailing Address - State:PA
Mailing Address - Zip Code:17876
Mailing Address - Country:US
Mailing Address - Phone:570-743-4333
Mailing Address - Fax:570-743-6012
Practice Address - Street 1:3166 N OLD TRAIL
Practice Address - Street 2:
Practice Address - City:SHAMOKIN DAM
Practice Address - State:PA
Practice Address - Zip Code:17876
Practice Address - Country:US
Practice Address - Phone:570-743-4333
Practice Address - Fax:570-743-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032484E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011475170006Medicaid
PA545802OtherBLUE SHIELD
E61961Medicare UPIN
PA0011475170006Medicaid