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NPI Code Detail

MEDICARE: DR. JACK BITTELL SEWELL M.D.

MEDICARE: DR. JACK BITTELL SEWELL M.D.
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
12085R0202XDiagnostic Radiology PhysicianME22971FL
22085R0202XDiagnostic Radiology Physician05320MS

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00041336OTHERFLMEDICARE RR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1134262411OTHERFLTAX ID
258248OTHERFLBCBS

General Provider Information

NPI Number : 1326032665
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACK BITTELL SEWELL M.D.
Provider Business Mailing Address
First Line : PO BOX 468
Second Line :
City : BERWICK
State : PA
Zip : 18603-0468
Country : US
Telephone Number : 610-956-0003
Fax Number :
Provider Business Practice Location Address
First Line : 901 E SUNFLOWER RD
Second Line :
City : CLEVELAND
State : MS
Zip : 38732-2833
Country : US
Telephone Number : 662-846-0061
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2005
Last Update Date : 06/15/2011

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