Provider Demographics
NPI:1861649113
Name:BLOOMSBURG PHYSICIANS SERVICES
Entity Type:Organization
Organization Name:BLOOMSBURG PHYSICIANS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-387-2148
Mailing Address - Street 1:549 FAIR ST
Mailing Address - Street 2:PO BOX 919
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-1419
Mailing Address - Country:US
Mailing Address - Phone:570-387-2100
Mailing Address - Fax:
Practice Address - Street 1:447 E 1ST ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1417
Practice Address - Country:US
Practice Address - Phone:570-784-5150
Practice Address - Fax:570-784-5620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA039145Medicare PIN