Provider Demographics
NPI:1902858301
Name:GEISINGER CLINIC
Entity Type:Organization
Organization Name:GEISINGER CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SYSTEM DIRECTOR ENROLLMENTS
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-271-6603
Mailing Address - Street 1:100 N ACADEMY
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-3034
Mailing Address - Country:US
Mailing Address - Phone:570-271-6211
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:RTE 11 LACKAWANNA TRAIL
Practice Address - Street 2:
Practice Address - City:NICHOLSON
Practice Address - State:PA
Practice Address - Zip Code:18446-3822
Practice Address - Country:US
Practice Address - Phone:570-942-6124
Practice Address - Fax:570-942-6193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-04-20
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-14
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207ZP0105X, 332B00000X, 363A00000X
PAMD044346E207Q00000X
PA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA711498Medicare PIN
PA0673670001Medicare NSC