MEDICARE: CENTER FOR UROLOGIC CARE OF BERKS CO PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	16741501	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1868	OTHER	PA	HIGHMARK BS FACILITY NUMB
2	390849	OTHER	PA	CAPITAL BC FACILITY

General Provider Information

NPI Number	:	1033116892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR UROLOGIC CARE OF BERKS CO PC

Provider Business Mailing Address
First Line	:	1320 BROADCASTING RD
Second Line	:	SUITE 210
City	:	WYOMISSING
State	:	PA
Zip	:	19610-3222
Country	:	US
Telephone Number	:	610-685-1044
Fax Number	:	610-685-1009

Provider Business Practice Location Address
First Line	:	1320 BROADCASTING RD
Second Line	:	SUITE 210
City	:	WYOMISSING
State	:	PA
Zip	:	19610-3222
Country	:	US
Telephone Number	:	610-685-1044
Fax Number	:	610-685-1009

Authorized Official
Title or Position	:	COO
Name	:	MR. HARRY MICHAEL BUCHMAN
Credential	:	MBA
Telephone Number	:	610-685-4510

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/26/2020

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