Provider Demographics
NPI:1134152564
Name:SCRANTON HEART INSTITUTE, P.C.
Entity type:Organization
Organization Name:SCRANTON HEART INSTITUTE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STAFFORD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-586-0246
Mailing Address - Street 1:102 N ABINGTON RD
Mailing Address - Street 2:SUITE #103
Mailing Address - City:CLARKS GREEN
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2300
Mailing Address - Country:US
Mailing Address - Phone:570-586-0246
Mailing Address - Fax:570-585-7890
Practice Address - Street 1:102 N ABINGTON RD
Practice Address - Street 2:SUITE #103
Practice Address - City:CLARKS GREEN
Practice Address - State:PA
Practice Address - Zip Code:18411-2300
Practice Address - Country:US
Practice Address - Phone:570-586-0246
Practice Address - Fax:570-585-7890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040434L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100585Medicare ID - Type Unspecified