Provider Demographics
NPI:1962451013
Name:GUTHRIE MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:GUTHRIE MEDICAL GROUP, P.C.
Other - Org Name:GUTHRIE CLINIC, LTD.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCOPELLITI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-888-5858
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:127 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:PA
Practice Address - Zip Code:17724-1733
Practice Address - Country:US
Practice Address - Phone:570-673-3197
Practice Address - Fax:570-673-8297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
PA003728291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGU618079OtherHIGHMARK BLUE SHIELD
PAGU618079OtherHIGHMARK BLUE SHIELD