=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700018470
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHWOOD HEALTH SERVICES, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2009
-----------------------------------------------------
Last Update Date | 08/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 SLATE BELT BLVD
-----------------------------------------------------
City | BANGOR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18013-9341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-588-0498
-----------------------------------------------------
Fax | 610-588-2145
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3729 EASTON NAZARETH HWY
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18045-8344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-559-7110
-----------------------------------------------------
Fax | 610-253-3216
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. DENISE KLOEPPING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 570-839-1422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------