Provider Demographics
NPI:1659702975
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:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:J
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 1:410 GLENN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1200
Practice Address - Country:US
Practice Address - Phone:570-317-2763
Practice Address - Fax:570-317-2764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine