Provider Demographics
NPI:1417078320
Name:NORTHERN BARIATRIC SURGERY INSTITUTE, INC.
Entity Type:Organization
Organization Name:NORTHERN BARIATRIC SURGERY INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-969-2527
Mailing Address - Street 1:114 REN ACRES
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9415
Mailing Address - Country:US
Mailing Address - Phone:570-969-2527
Mailing Address - Fax:
Practice Address - Street 1:1400 MAIN ST
Practice Address - Street 2:MVH PROFESSIONAL SERVICES BLDG
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2009
Practice Address - Country:US
Practice Address - Phone:570-969-2527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004198L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty