Provider Demographics
NPI:1669721197
Name:LAUREL MANAGEMENT SERVICES
Entity type:Organization
Organization Name:LAUREL MANAGEMENT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-723-0100
Mailing Address - Street 1:15 MEADE ST
Mailing Address - Street 2:SUITE U6
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1813
Mailing Address - Country:US
Mailing Address - Phone:570-723-0100
Mailing Address - Fax:570-724-2126
Practice Address - Street 1:25 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1515
Practice Address - Country:US
Practice Address - Phone:570-724-0615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAUREL MANAGEMENT SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine