| Kanouse Medical Group Pc | |
|
695 E 16th St Suite D Berwick PA 18603-2320 | |
| (570) 752-5500 | |
| (570) 752-6790 |
| Full Name | Kanouse Medical Group Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 695 E 16th St, Berwick, Pennsylvania |
| Authorized Official Name and Position | Gary Douglas Kanouse (PHYSICIAN) |
| Authorized Official Contact | 5707525500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kanouse Medical Group Pc 695 E 16th St Suite D Berwick PA 18603-2320 Ph: (570) 752-5500 | Kanouse Medical Group Pc 695 E 16th St Suite D Berwick PA 18603-2320 Ph: (570) 752-5500 |
| NPI Number | 1790859783 |
|---|---|
| Provider Enumeration Date | 11/20/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4789659210 |
|---|---|
| Medicare Enrollment ID | O20040830000038 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790859783 | NPI | - | NPPES |
| 50002681 | Other | PA | CAPITAL BLUE CROSS |
| 1335094 | Other | PA | HIGHMARK BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD-036479-E (Pennsylvania) | Primary |
| Provider Name | Gary D Kanouse |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568521425 PECOS PAC ID: 6103082953 Enrollment ID: I20120723000565 |
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