| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 301w 3rd Street, Berwick, Pennsylvania |
| Authorized Official Name and Position | Albert Joseph Alley (OWNER MEDICAL DIRECTOR) |
| Authorized Official Contact | 5707590351 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
301w 3rd Street Berwick PA 18603 Ph: (570) 759-0351 | 301w 3rd Street Berwick PA 18603 Ph: (570) 759-0351 |
| NPI Number | 1962479717 |
|---|---|
| Provider Enumeration Date | 03/01/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962479717 | NPI | - | NPPES |
| 03161300 | Other | BC | |
| 1007302700004 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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