Basic Information
| Provider Information | |||||||||
| NPI: | 1235306879 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BLOOMSBURG PHYSICIANS SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 549 FAIR ST | ||||||||
| Address2: | PO BOX 919 | ||||||||
| City: | BLOOMSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178151419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703872100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 480 CENTRAL RD | ||||||||
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| City: | BLOOMSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178153121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703876150 | ||||||||
| FaxNumber: | 5703876185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2008 | ||||||||
| LastUpdateDate: | 09/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | CABONOR | ||||||||
| AuthorizedOfficialFirstName: | REGIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5703872100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.