Organization
BLOOMSBURG PHYSICIAN SERVICES
Active
Other names
BLOOMSBURG PHYSICIAN SERVICES GEN SURG
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH DEVITO (CFO)
(570) 387-2148
Entity
Organization
Contact information
Practice address
410 GLENN AVE, SUITE 203, BLOOMSBURG, PA 17815-1200
(570) 387-2339
(570) 387-2487
Mailing address
410 GLENN AVE, SUITE 203, BLOOMSBURG, PA 17815-1200
(570) 387-2339
(570) 387-2487
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014107290004
—
PA
01
—
50052731
CBC NUMBER
PA
01
—
739865
HIGHMARK NUMBER
PA
01
—
8807
GHP NUMBER
PA
Enumeration date
05/17/2007
Last updated
08/22/2020
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