CLEANSLATE MEDICAL GROUP OF PENNSYLVANIA LLC (NPI# 1184177263) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184177263 |
| Entity Type | Organization |
| Organization Name | CLEANSLATE MEDICAL GROUP OF PENNSYLVANIA LLC |
| Practice Address |
100 N Wilkes Barre Blvd Ste 103 Wilkes Barre PA 18702-5240 |
| Mailing Address |
15 Century Blvd Ste 307 Nashville TN 37214-3692 |
| Practice Telephone | 4135842173 |
| Practice Fax Number | 4137273619 |
| Mailing Telephone | 6154250220 |
| Mailing Fax Number | 4137273619 |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2019-07-02 |
| Authorized Official Name | MR. ROBERT HUTCHISON (CHIEF FIN. OFFICER) |
| Authorized Official Telephone | 6154250220 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
100 N WILKES BARRE BLVD STE 103 |
| City | WILKES BARRE |
| State | PA |
| Zip Code | 18702-5240 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750908224 | Edward John Kerwin | Peer Specialist | 100 N Wilkes Barre Blvd Ste 103, Wilkes Barre, PA 18702-5240 | 2020-07-01 |
| 1346867819 | Lauren Elizabeth Gardjulis | Peer Specialist | 100 N Wilkes Barre Blvd Ste 103, Wilkes Barre, PA 18702-5240 | 2020-07-01 |
| 1679190052 | Nicole Marie Wenrich | Peer Specialist | 100 N Wilkes Barre Blvd Ste 103, Wilkes Barre, PA 18702-5240 | 2020-07-01 |
| 1982221453 | Shauna Lee Fedak | Peer Specialist | 100 N Wilkes Barre Blvd Ste 103, Wilkes Barre, PA 18702-5240 | 2020-07-01 |
| 1770100141 | Katrina Favata | Peer Specialist | 100 N Wilkes Barre Blvd Ste 103, Wilkes Barre, PA 18702-5240 | 2020-07-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477153161 | Joann Bonn | Pharmacist | 441 Wilkes-barre Township Blvd, Wilkes-barre, PA 18702 | 2020-10-30 |
| 1689213167 | Megan Grace Zanghi | Pharmacist | 58-60 Public Square, 4th Floor, Wilkes-barre, PA 18702 | 2019-12-31 |
| 1467013292 | Kelly Rose Sones | Pharmacist | 58/60 Public Square, Wilkes-barre, PA 18702 | 2019-06-24 |
| 1528520186 | Adam Olivetti | Pharmacist | 58-60 Public Square, Wilkes-barre, PA 18702 | 2019-04-03 |
| 1295220648 | Dental Associates of Nepa PC | Dentist | 360 Kidder Street, Suite 5, Wilkes Barre, PA 18702 | 2018-06-28 |
| 1568983245 | Bio-medical Applications of Pennsylavania, Inc. | Clinic/Center | 309 Laird St, Wilkes-barre, PA 18702 | 2017-07-03 |
| 1538615166 | Elsa Gates | Nurse Practitioner | 100 East Mountain Blvd, Geisinger, Wilkes Barre, PA 18702 | 2016-09-01 |
| 1972990455 | Epeople Health Care Inc. | Home Health | 1092 Route 315, Ste 3, Wilkes Barre, PA 18702 | 2015-04-22 |
| 1063819001 | Visionworks, Inc. | Eyewear Supplier (Equipment, not the service) | 277 Mundy St, Suite 101, Wilkes Barre, PA 18702 | 2014-11-19 |
| 1356764013 | Jill Stacchiotti | Speech-Language Pathologist | 2 Salem Drive, Laflin, PA 18702 | 2014-01-30 |
| Find all providers in zip 18702 | ||||
| Taxonomy Code | 207RA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Addiction Medicine |
| An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053957613 | Global Health and Recovery Services LLC | Internal Medicine | 3229 Kensington Ave, Philadelphia, PA 19134-1934 | 2019-11-19 |
| 1952946253 | Kaitlyn Renee Mackey | Internal Medicine | 33 Rollins Ln, Willow Street, PA 17584-8606 | 2019-11-10 |
| 1831559814 | Roxanne Rick | Internal Medicine | 2501 Mckeever St, Monongahela, PA 15063-4549 | 2016-03-03 |
| 1770960882 | Medically Assisted Recovery Services Inc | Internal Medicine | 10802 Bustleton Ave, Philadelphia, PA 19116-3302 | 2015-04-28 |
| 1013301985 | Karen Sees | Internal Medicine | 1266 Lindholm Road, Kane, PA 16735 | 2015-03-27 |
| 1144473208 | Christopher Jackson Davis | Internal Medicine | 320 Loucks Rd, Suite 103, York, PA 17404-1752 | 2008-11-02 |
| 1598937245 | James Craig Berman | Internal Medicine | 261 Standish Rd, Merion Station, PA 19066-1133 | 2008-04-01 |
| 1407027725 | Trusandra Elaine Taylor | Internal Medicine | 1745 N 4th St, Philadelphia, PA 19122-3008 | 2008-03-14 |
| 1619081726 | Bernard Amiel Harris | Internal Medicine | 2205 Bridge St, Philadelphia, PA 19137-1313 | 2006-08-18 |
| 1255365151 | Kenneth W Thompson | Internal Medicine | 17 Camp Road, Richard J Caron Foundation, Wernersville, PA 19565 | 2006-07-10 |
| Find all providers with the same taxonomy | ||||
| City | WILKES BARRE |
| Zip Code | 18702 |
Please comment or provide details below to improve the information on CLEANSLATE MEDICAL GROUP OF PENNSYLVANIA LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.