Provider Demographics
NPI:1497896328
Name:MID-STATE OCCUPATIONAL HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:MID-STATE OCCUPATIONAL HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-327-8790
Mailing Address - Street 1:2605 REACH RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-4392
Mailing Address - Country:US
Mailing Address - Phone:570-327-8790
Mailing Address - Fax:570-321-9504
Practice Address - Street 1:2605 REACH RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-4392
Practice Address - Country:US
Practice Address - Phone:570-327-8790
Practice Address - Fax:570-321-9504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025258E2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty