NPIMap

Organization Active NPI

Bloomsburg Physicians Services

  • Internal Medicine Physician
  • Bloomsburg, PA
National Provider Identifier
1689857070
Registry record updated Dec 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD421245 Issued in PA
Legal business name
BLOOMSBURG PHYSICIANS SERVICES
Practice address
410 Glenn Ave
Suite 304
Bloomsburg, PA 17815-1200
Phone
(570) 387-7676
Fax
(570) 387-7677
NPI assigned
Dec 10, 2007
Last updated
Dec 10, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2007

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD421245 PA Primary

Addresses

Primary practice location

410 Glenn Ave
Suite 304
Bloomsburg, PA 17815-1200

Mailing address

549 Fair St
Bloomsburg, PA 17815-1419
Phone (570) 387-2100

Other identifiers 1

IdentifierTypeStateIssuer
1487886OtherPAHIGHMARK BLUE SHIELD

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

Locations

410 Glen Ave
Ste 304
Bloomsburg, PA 17815
Phone (570) 387-7676

NPI Registry JSON

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

{
    "created_epoch": "1197244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197244800000",
    "number": "1689857070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "549 FAIR ST",
            "city": "BLOOMSBURG",
            "state": "PA",
            "postal_code": "178151419",
            "telephone_number": "570-387-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 GLENN AVE",
            "address_2": "SUITE 304",
            "city": "BLOOMSBURG",
            "state": "PA",
            "postal_code": "178151200",
            "telephone_number": "570-387-7676",
            "fax_number": "570-387-7677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMSBURG PHYSICIANS SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-10",
        "last_updated": "2007-12-10",
        "status": "A",
        "authorized_official_last_name": "DEVITO",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "570-387-2148",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD421245",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "1487886",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Dec 10, 2007; 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.