Provider Demographics
NPI:1568457935
Name:BERKSHIRE FAMILY MEDICINE, PC
Entity Type:Organization
Organization Name:BERKSHIRE FAMILY MEDICINE, PC
Other - Org Name:COMPREHENSIVE ATHLETIC TRAINING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DIEHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-685-9600
Mailing Address - Street 1:1350 BROADCASTING RD
Mailing Address - Street 2:STE 201
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3220
Mailing Address - Country:US
Mailing Address - Phone:610-685-9600
Mailing Address - Fax:610-685-6700
Practice Address - Street 1:1350 BROADCASTING RD
Practice Address - Street 2:STE 201
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3220
Practice Address - Country:US
Practice Address - Phone:610-685-9600
Practice Address - Fax:610-685-6700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3000329OtherKEYSTONE HEALTH PLAN CENT
1642082OtherPA BLUE SHIELD
50039846OtherCAPITAL BLUE CROSS
244757OtherHEALTH ASSURANCE HEALTH A
PA5470550001Medicare NSC
3000329OtherKEYSTONE HEALTH PLAN CENT