Organization
CARBON MEDICAL ASSOC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLY SUSAN BOCK (OFFICE MANAGER)
(610) 824-3752
Entity
Organization
Contact information
Practice address
218A DELAWARE AVE, PALMERTON, PA 18071-1813
(610) 826-6353
(610) 826-6359
Mailing address
218A DELAWARE AVE, PALMERTON, PA 18071-1813
(610) 826-6353
(610) 826-6359
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207RN0300X
Nephrology Physician
—
—
363AM0700X
Medical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016426800005
—
PA
01
—
02292600
CAPITAL BLUE CROSS
PA
01
—
869935
BLUE SHIELD GROUP NUMBER
PA
Enumeration date
06/30/2006
Last updated
11/08/2007
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