Provider Demographics
NPI:1619033560
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 ROUTE 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:RR #1 BOX 414
Practice Address - Street 2:COLUMBIA ANCILLARY SERVICES INC
Practice Address - City:MOUNT CLARE
Practice Address - State:WV
Practice Address - Zip Code:26408
Practice Address - Country:US
Practice Address - Phone:304-622-2635
Practice Address - Fax:304-622-2271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332B00000X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3810008843Medicaid
PA0340620003Medicare NSC