MEDICARE: SWITCHBACK MEDICAL CENTER 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	207Q00000X	Family Medicine Physician	MD-023853-E	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH7812	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0916600	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1487773966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWITCHBACK MEDICAL CENTER PC

Provider Business Mailing Address
First Line	:	1580 CENTER AVE
Second Line	:
City	:	JIM THORPE
State	:	PA
Zip	:	18229-1012
Country	:	US
Telephone Number	:	570-325-2705
Fax Number	:	570-325-8310

Provider Business Practice Location Address
First Line	:	1580 CENTER AVE
Second Line	:
City	:	JIM THORPE
State	:	PA
Zip	:	18229-1012
Country	:	US
Telephone Number	:	570-325-2705
Fax Number	:	570-325-8310

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	DR. DEBORAH A SMITH
Credential	:	MD
Telephone Number	:	570-325-2705

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	04/03/2008

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Directions to “SWITCHBACK MEDICAL CENTER PC ” Practice Location

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