| Glenn Ave Family Practice | |
|
410 Glenn Ave Suite 303 Bloomsburg PA 17815-1419 | |
| (570) 387-2166 | |
| (570) 387-2316 |
| Full Name | Glenn Ave Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 410 Glenn Ave, Bloomsburg, Pennsylvania |
| Authorized Official Name and Position | Kristin A Hollister (ASSISTANT PRACTICE MANAGER) |
| Authorized Official Contact | 5703872166 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Glenn Ave Family Practice 401 Glenn Ave Bloomsburg PA 17815-1419 Ph: (570) 784-6077 | Glenn Ave Family Practice 410 Glenn Ave Suite 303 Bloomsburg PA 17815-1419 Ph: (570) 387-2166 |
| NPI Number | 1588869515 |
|---|---|
| Provider Enumeration Date | 06/19/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588869515 | NPI | - | NPPES |
| 50065262 | Other | PA | CBC |
| 91151C336 | Other | PA | GHP |
| 1388085 | Other | PA | SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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