Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

CLEANSLATE MEDICAL GROUP OF PENNSYLVANIA LLC
NPI 1184177263
Clinic/Center - Multi-Specialty in Wilkes Barre, PA

Q: What is Cleanslate Medical Group Of Pennsylvania LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

Active since July 26, 2016

100 N WILKES BARRE BLVD STE 103, WILKES BARRE, PA 18702(413) 584-2173(833) 279-7074 Get Directions Write a Review

NPPES record last updated: August 26, 2026. Verified against the NPPES registry weekly; last sync: September 13, 2026.

Record update history: Aug 26, 2026, Dec 17, 2025, May 8, 2025 and 6 more (9 updates tracked since 2017).

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About Cleanslate Medical Group Of Pennsylvania Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CLEANSLATE MEDICAL GROUP OF PENNSYLVANIA LLC (NPI 1184177263) is a healthcare organization registered as a multi-specialty in Wilkes Barre, Pennsylvania and active in the NPI registry since July 2016. The organization lists Paul Rogers Anderson, Vice President, as its authorized official.

NPPES Registry Identity

NPI1184177263

Entity TypeOrganization

Primary Taxonomy261QM1300X

Legal Business NameCLEANSLATE MEDICAL GROUP OF PENNSYLVANIA LLC

Location Address100 N WILKES BARRE BLVD STE 103Wilkes Barre, PA 18702-5240

Mailing Address155 Franklin Rd Ste 430Brentwood, TN 37027-1602 · (615) 425-0220 · Fax (833) 279-7074

Phone(413) 584-2173

Fax(833) 279-7074

Organization SubpartNo

Authorized OfficialPaul Rogers AndersonVice President · (615) 425-0220

Enumeration DateJuly 26, 2016

Last NPPES UpdateAugust 26, 20269 updates tracked since enumeration

NPPES CertifiedAugust 26, 2026

✔ NPI 1184177263 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities

Taxonomy Code261QM1300X

Also ListedInternal Medicine · Addiction MedicineTaxonomy 207RA0401X

100 N WILKES BARRE BLVD STE 103, Wilkes Barre, PA 18702

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter Health, Ambetter Health of Delaware and more.Insurance ›

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FLORENCE BABIARZ

Counselor (Addiction (Substance Use Disorder))