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General NPI Number Information
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NPI Number | 1477758407
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Entity Type | Organization
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Legal Business Name | BLOOMSBURG PHYSICIANS SERVICES
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 WEST 9TH STREET
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City | BERWICK
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State | PA
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Zip | 18603
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Country | US
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Telephone | 570-387-2166
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Fax | 570-387-2316
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Provider Business Mailing Address
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Address Line | 401 GLENN AVE
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City | BLOOMSBURG
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State | PA
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Zip | 17815-1419
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Country | US
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Telephone | 570-759-2600
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Fax | 570-759-3229
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Authorized Official
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Title or Position | ASSISTANT PRACTICE MANAGER
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Name | MR. KRISTIN A HOLLISTER
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Credential |
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Telephone | 570-387-2166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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