Provider Demographics
NPI:1124053780
Name:SOUTHEASTERN BERKS INTERNAL MEDICINE ASSOCIATES,LTD
Entity type:Organization
Organization Name:SOUTHEASTERN BERKS INTERNAL MEDICINE ASSOCIATES,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CLAYMONT
Authorized Official - Last Name:HEISEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-779-0300
Mailing Address - Street 1:4885 DEMOSS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-9023
Mailing Address - Country:US
Mailing Address - Phone:610-779-0300
Mailing Address - Fax:610-779-8083
Practice Address - Street 1:4885 DEMOSS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-9023
Practice Address - Country:US
Practice Address - Phone:610-779-0300
Practice Address - Fax:610-779-8083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA152998Medicare ID - Type Unspecified