Healthcare Provider Details

I. General information

NPI: 1821332008
Provider Name (Legal Business Name): CHS PROFESSIONAL PRACTICE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2012
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 STATION CIR
HAZLETON PA
18202-9726
US

IV. Provider business mailing address

2775 SCHOENERSVILLE RD
BETHLEHEM PA
18017-7307
US

V. Phone/Fax

Practice location:
  • Phone: 610-861-8080
  • Fax: 570-497-4046
Mailing address:
  • Phone: 610-861-8080
  • Fax: 610-861-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: AMY NYBERG
Title or Position: PRESIDENT & COO
Credential:
Phone: 610-861-8080