NPIMap

Organization Active NPI

Bloomsburg Physician Services

  • Obstetrics & Gynecology Physician
  • Bloomsburg, PA
National Provider Identifier
1124236708
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
BLOOMSBURG PHYSICIAN SERVICES
Practice address
410 Glenn Ave
Suite 2
Bloomsburg, PA 17815-1200
Phone
(570) 387-2474
Fax
(570) 387-2397
NPI assigned
May 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Joseph Devito
Title
Cfo
Phone
(570) 387-2148

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

410 Glenn Ave
Suite 2
Bloomsburg, PA 17815-1200

Mailing address

410 Glenn Ave
Suite 2
Bloomsburg, PA 17815-1200
Phone (570) 387-2474

Other identifiers 5

IdentifierTypeStateIssuer
1015090000002MedicaidPA
94984OtherPAGHP NUMBER
1388085OtherPAHIGHMARK NUMBER
50052725OtherPACBC NUMBER
819545OtherPAFIRST PRIORITY

Other names 1

  • BLOOMSBURG PHYSICIAN SERVICES OBGYN Other name

National Provider Directory

National Provider Directory
Tax ID family
Bloomsburg Physicians Services14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124236708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 GLENN AVE",
            "address_2": "SUITE 2",
            "city": "BLOOMSBURG",
            "state": "PA",
            "postal_code": "178151200",
            "telephone_number": "570-387-2474",
            "fax_number": "570-387-2397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 GLENN AVE",
            "address_2": "SUITE 2",
            "city": "BLOOMSBURG",
            "state": "PA",
            "postal_code": "178151200",
            "telephone_number": "570-387-2474",
            "fax_number": "570-387-2397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMSBURG PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEVITO",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "570-387-2148",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1015090000002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP NUMBER",
            "identifier": "94984",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK NUMBER",
            "identifier": "1388085",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CBC NUMBER",
            "identifier": "50052725",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY",
            "identifier": "819545",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BLOOMSBURG PHYSICIAN SERVICES OBGYN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bloomsburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.