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General NPI Number Information
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NPI Number | 1417078320
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Entity Type | Organization
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Legal Business Name | NORTHERN BARIATRIC SURGERY INSTITUTE, INC.
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1400 MAIN ST MVH PROFESSIONAL SERVICES BLDG
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City | PECKVILLE
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State | PA
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Zip | 18452-2009
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Country | US
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Telephone | 570-969-2527
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Fax |
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Provider Business Mailing Address
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Address Line | 114 REN ACRES
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City | CLARKS SUMMIT
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State | PA
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Zip | 18411-9415
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Country | US
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Telephone | 570-969-2527
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM S. PETERS
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Credential | D.O.
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Telephone | 570-969-2527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | OS004198L
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License Number State | PA
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