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1227 W Liberty St Liberty Plaza, Suite 104 Allentown PA 18102-2604 | |
(610) 432-3455 | |
(610) 432-1221 |
Full Name | |
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Speciality | Clinic/center |
Location | 1227 W Liberty St, Allentown, Pennsylvania |
Authorized Official Name and Position | Richard W Mackey (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 5708261777 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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15 Public Sq Suite 600 Wilkes Barre PA 18701-1702 Ph: (570) 826-1777 | 1227 W Liberty St Liberty Plaza, Suite 104 Allentown PA 18102-2604 Ph: (610) 432-3455 |
NPI Number | 1942525001 |
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Provider Enumeration Date | 04/01/2010 |
Last Update Date | 12/02/2011 |
Identifier | Type | State | Issuer |
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1942525001 | NPI | - | NPPES |
1007678420037 | Medicaid | PA | |
1026262170001 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | MD055164L (Pennsylvania) | Primary |