| Smg Tri-state Region | |
|
21 Corporate Dr Ste. 1 Easton PA 18045-2664 | |
| (615) 467-4158 | |
| (615) 467-1267 |
| Full Name | Smg Tri-state Region |
|---|---|
| Speciality | Family Medicine |
| Location | 21 Corporate Dr, Easton, Pennsylvania |
| Authorized Official Name and Position | Ashley Koch (CFO) |
| Authorized Official Contact | 6175625359 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Smg Tri-state Region 9 Galen St Watertown MA 02472-4515 Ph: (617) 562-5359 | Smg Tri-state Region 21 Corporate Dr Ste. 1 Easton PA 18045-2664 Ph: (615) 467-4158 |
| NPI Number | 1073054458 |
|---|---|
| Provider Enumeration Date | 03/17/2017 |
| Last Update Date | 08/13/2020 |
| Medicare PECOS PAC ID | 2860688728 |
|---|---|
| Medicare Enrollment ID | O20170626001510 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073054458 | NPI | - | NPPES |
| Provider Name | Michael J Pereira |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1578675112 PECOS PAC ID: 0244266690 Enrollment ID: I20050718000020 |
| Provider Name | Jaimee L Ramsden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821312612 PECOS PAC ID: 0446387609 Enrollment ID: I20170410000707 |
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