Healthcare Provider Details

I. General information

NPI: 1619033560
Provider Name (Legal Business Name): COLUMBIA ANCILLARY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR #1 BOX 414 COLUMBIA ANCILLARY SERVICES INC
MOUNT CLARE WV
26408
US

IV. Provider business mailing address

1388 STATE ROUTE 487
BLOOMSBURG PA
17815
US

V. Phone/Fax

Practice location:
  • Phone: 304-622-2635
  • Fax: 304-622-2271
Mailing address:
  • Phone: 570-784-1410
  • Fax: 800-326-8307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StatePA

VIII. Authorized Official

Name: MR. BRIAN D KLINGERMAN
Title or Position: PRESIDENT
Credential:
Phone: 570-784-1410