NPIMap

Organization Active NPI

Bloomsburg Physician Services

  • Surgery Physician
  • Bloomsburg, PA
National Provider Identifier
1770790974
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
BLOOMSBURG PHYSICIAN SERVICES
Practice address
410 Glenn Ave
Suite 203
Bloomsburg, PA 17815-1200
Phone
(570) 387-2339
Fax
(570) 387-2487
NPI assigned
May 17, 2007
Last updated
Aug 22, 2020By the provider in NPPES
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
Surgery Physician 208600000X Primary

Addresses

Primary practice location

410 Glenn Ave
Suite 203
Bloomsburg, PA 17815-1200

Mailing address

410 Glenn Ave
Suite 203
Bloomsburg, PA 17815-1200
Phone (570) 387-2339

Other identifiers 4

IdentifierTypeStateIssuer
8807OtherPAGHP NUMBER
0014107290004MedicaidPA
50052731OtherPACBC NUMBER
739865OtherPAHIGHMARK NUMBER

Other names 1

  • BLOOMSBURG PHYSICIAN SERVICES GEN SURG 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

Locations

410 Glen Ave
Ste 203
Bloomsburg, PA 17815
Phone (570) 387-2339

NPI Registry JSON

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770790974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 GLENN AVE",
            "address_2": "SUITE 203",
            "city": "BLOOMSBURG",
            "state": "PA",
            "postal_code": "178151200",
            "telephone_number": "570-387-2339",
            "fax_number": "570-387-2487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 GLENN AVE",
            "address_2": "SUITE 203",
            "city": "BLOOMSBURG",
            "state": "PA",
            "postal_code": "178151200",
            "telephone_number": "570-387-2339",
            "fax_number": "570-387-2487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMSBURG PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "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": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP NUMBER",
            "identifier": "8807",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0014107290004",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CBC NUMBER",
            "identifier": "50052731",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK NUMBER",
            "identifier": "739865",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BLOOMSBURG PHYSICIAN SERVICES GEN SURG",
            "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.