Basic Information
| Provider Information | |||||||||
| NPI: | 1609883628 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VA MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 SCHOOLHOUSE RD. | ||||||||
| Address2: | |||||||||
| City: | TUNKHANNOCK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703335224 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 EAST END BLVD. | ||||||||
| Address2: | |||||||||
| City: | WILKES-BARRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708243521 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ECKENRODE | ||||||||
| AuthorizedOfficialFirstName: | GERALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | RESPIRATORY THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 5708243521 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | RRT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | YM000449L | PA | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.