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General NPI Number Information
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NPI Number | 1659702975
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Entity Type | Organization
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Legal Business Name | MID-STATE OCCUPATIONAL HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 12/12/2013
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Last Update Date | 12/12/2013
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Provider Practice Location Address
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Address Line | 410 GLENN AVE SUITE 2
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City | BLOOMSBURG
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State | PA
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Zip | 17815-1200
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Country | US
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Telephone | 570-317-2763
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Fax | 570-317-2764
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Provider Business Mailing Address
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Address Line | 2605 REACH RD
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-4392
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Country | US
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Telephone | 570-327-8790
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Fax | 570-321-9504
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Authorized Official
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Title or Position | PRESIDENT
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Name | DERRICK J DUFF
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Credential |
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Telephone | 570-327-8790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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