Organization
BLOOMSBURG PHYSICIANS SERVICES
Active
Other names
GLENN AVE FAMILY PRACTICE
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISTIN A HOLLISTER (ASSISTANT PRACTICE MANAGER)
(570) 387-2166
Entity
Organization
Contact information
Practice address
410 GLENN AVE, SUITE 303, BLOOMSBURG, PA 17815-1419
(570) 387-2166
(570) 387-2316
Mailing address
401 GLENN AVE, BLOOMSBURG, PA 17815-1419
(570) 784-6077
(570) 387-2029
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1388085
SHIELD
PA
01
—
50065262
CBC
PA
01
—
91151C336
GHP
PA
Enumeration date
06/19/2007
Last updated
08/22/2020
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