Provider Demographics
NPI:1477758407
Name:BLOOMSBURG PHYSICIANS SERVICES
Entity Type:Organization
Organization Name:BLOOMSBURG PHYSICIANS SERVICES
Other - Org Name:JOSE DERR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-387-2166
Mailing Address - Street 1:401 GLENN AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-1419
Mailing Address - Country:US
Mailing Address - Phone:570-759-2600
Mailing Address - Fax:570-759-3229
Practice Address - Street 1:101 WEST 9TH STREET
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603
Practice Address - Country:US
Practice Address - Phone:570-387-2166
Practice Address - Fax:570-387-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50047313OtherCBC