MEDICARE: CLINICAL COLLEAGUES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist
2	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1033568605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL COLLEAGUES INC

Provider Business Mailing Address
First Line	:	PO BOX 824246
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-8246
Country	:	US
Telephone Number	:	954-570-0337
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 BETHLEHEM PIKE
Second Line	:	SUTIE 60-234
City	:	SPRING HOUSE
State	:	PA
Zip	:	19477-1102
Country	:	US
Telephone Number	:	800-494-3964
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	PAUL GERDES
Credential	:
Telephone Number	:	800-494-3964

Provider Enumeration Date	:	06/06/2016
Last Update Date	:	08/11/2021

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