| Lifeback Of Pennsylvania Llc | |
|
10 S Clinton St Ste 100 Doylestown PA 18901-4220 | |
| (609) 482-3701 | |
| (215) 975-7300 |
| Full Name | Lifeback Of Pennsylvania Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10 S Clinton St Ste 100, Doylestown, Pennsylvania |
| Authorized Official Name and Position | Marinetta Serotte (PRESIDENT) |
| Authorized Official Contact | 6094823701 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifeback Of Pennsylvania Llc 10 S Clinton St Ste 100 Doylestown PA 18901-4220 Ph: (609) 482-3701 | Lifeback Of Pennsylvania Llc 10 S Clinton St Ste 100 Doylestown PA 18901-4220 Ph: (609) 482-3701 |
| NPI Number | 1457879520 |
|---|---|
| Provider Enumeration Date | 09/08/2017 |
| Last Update Date | 12/28/2023 |
| Certification Date | 11/21/2023 |
| Medicare PECOS PAC ID | 7517300775 |
|---|---|
| Medicare Enrollment ID | O20240205004022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457879520 | NPI | - | NPPES |
| Provider Name | Stephan Brautigam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215392550 PECOS PAC ID: 0840698593 Enrollment ID: I20211011000310 |
| Provider Name | Gregory K Smola |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124674841 PECOS PAC ID: 2264894013 Enrollment ID: I20240304003770 |
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