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701 E 16th St Berwick PA 18603-2316 | |
| (570) 759-5000 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Ambulatory Surgical |
| Location | 701 E 16th St, Berwick, Pennsylvania |
| Authorized Official Name and Position | Paula Lalor (DIRECTOR/DELEGATED OFFICIAL) |
| Authorized Official Contact | 6159254565 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
701 E 16th St Berwick PA 18603-2316 Ph: (570) 759-5000 | 701 E 16th St Berwick PA 18603-2316 Ph: (570) 759-5000 |
| NPI Number | 1366657116 |
|---|---|
| Provider Enumeration Date | 05/14/2007 |
| Last Update Date | 04/08/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366657116 | NPI | - | NPPES |
| 1007562590003 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 024901 (Pennsylvania) | Secondary |
| 261QA1903X | Clinic/center - Ambulatory Surgical | 024901 (Pennsylvania) | Primary |
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