Organization
BERWICK CLINIC COMPANY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE T BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(615) 465-7626
Entity
Organization
Contact information
Practice address
751 E 16TH ST, SUITE 400, BERWICK, PA 18603-2321
(505) 759-5555
(505) 759-5553
Mailing address
751 E 16TH ST, SUITE 400, BERWICK, PA 18603-2321
(505) 759-5555
(505) 759-5553
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207T00000X
Neurological Surgery Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207VE0102X
Reproductive Endocrinology Physician
—
—
208000000X
Pediatrics Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1018125400001
—
PA
05
—
1018125400003
—
PA
01
—
1917716
HIGMARK BLUE SHIELD
PA
Enumeration date
11/06/2006
Last updated
10/26/2009
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