Provider Demographics
NPI:1568676930
Name:COLUMBIA ANCILLARY SERVICES INC
Entity Type:Organization
Organization Name:COLUMBIA ANCILLARY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KLINGERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-784-1410
Mailing Address - Street 1:1388 STATE RT 487
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815
Mailing Address - Country:US
Mailing Address - Phone:570-784-1410
Mailing Address - Fax:800-326-8307
Practice Address - Street 1:563 CAREY AVE
Practice Address - Street 2:COLUMBIA ANCILLARY SERVICES INC
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18703
Practice Address - Country:US
Practice Address - Phone:570-208-3803
Practice Address - Fax:570-820-7182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332B00000X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007522780007Medicaid
PA1007522780007Medicaid