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General NPI Number Information
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NPI Number | 1235187006
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Entity Type | Organization
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Legal Business Name | BERWICK MEDICAL PROFESSIONALS PC
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 751 E 16TH ST
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City | BERWICK
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State | PA
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Zip | 18603-2321
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Country | US
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Telephone | 570-759-5555
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Fax | 570-759-5553
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Provider Business Mailing Address
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Address Line | PO BOX 504304
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City | SAINT LOUIS
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State | MO
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Zip | 63150-0001
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Country | US
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Telephone | 570-759-5555
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Fax | 570-759-5553
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Authorized Official
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Title or Position | SENIOR VP
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Name | GARY NEWSOME
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Credential |
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Telephone | 570-759-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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