| Methodist Services | |
|
51 Market St Bangor PA 18013-1901 | |
| (610) 588-9109 | |
| (610) 588-5016 |
| Full Name | Methodist Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 51 Market St, Bangor, Pennsylvania |
| Authorized Official Name and Position | Anita Howard (ADMINISTRATOR OF GRANTS AND CONTRAC) |
| Authorized Official Contact | 2158771925 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Methodist Services 4300 Monument Rd Philadelphia PA 19131-1616 Ph: (215) 877-1925 | Methodist Services 51 Market St Bangor PA 18013-1901 Ph: (610) 588-9109 |
| NPI Number | 1457386328 |
|---|---|
| Provider Enumeration Date | 07/11/2006 |
| Last Update Date | 12/15/2021 |
| Certification Date | 12/15/2021 |
| Medicare PECOS PAC ID | 5193034718 |
|---|---|
| Medicare Enrollment ID | O20151022001074 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457386328 | NPI | - | NPPES |
| 1019507060009 | Medicaid | PA | |
| 1019507060006 | Medicaid | PA |
| Provider Name | John Paul Gomez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811958366 PECOS PAC ID: 4284604190 Enrollment ID: I20050929001245 |
| Provider Name | Mary Wertheimer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093995227 PECOS PAC ID: 7214126184 Enrollment ID: I20111121000638 |
| Provider Name | Carol Olzinski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518261593 PECOS PAC ID: 5193969103 Enrollment ID: I20130912000703 |
| Provider Name | Amanda L Lehman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821532276 PECOS PAC ID: 6709163728 Enrollment ID: I20170501000602 |
| Provider Name | Hinna Ehsanullah Shah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083911598 PECOS PAC ID: 7911145966 Enrollment ID: I20190809000786 |
| Provider Name | Kimberly Niyogi |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033615240 PECOS PAC ID: 1456701473 Enrollment ID: I20240322002007 |
| Provider Name | Bethel Sucro |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942366497 PECOS PAC ID: 7214388248 Enrollment ID: I20240410000876 |
| Provider Name | James Wesner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811216492 PECOS PAC ID: 8123478120 Enrollment ID: I20240426002166 |
| Provider Name | Elizabeth Kostura |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629492608 PECOS PAC ID: 4789034786 Enrollment ID: I20240501002499 |
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