Provider Demographics
NPI:1932326899
Name:GUTHRIE MEDICAL GROUP PC
Entity Type:Organization
Organization Name:GUTHRIE MEDICAL GROUP PC
Other - Org Name:GUTHRIE CLINIC LTD (MIDWIVES)
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT & COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCOPELITTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-888-5858
Mailing Address - Street 1:1 GUTHRIE SQUARE
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1698
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQUARE
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1698
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007332090164Medicaid