Provider Demographics
NPI:1972991339
Name:BI INCORPORATED
Entity type:Organization
Organization Name:BI INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AREA MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WIRTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-208-4858
Mailing Address - Street 1:125 N WILKES BARRE BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-5354
Mailing Address - Country:US
Mailing Address - Phone:570-208-4858
Mailing Address - Fax:570-822-5784
Practice Address - Street 1:499 MANOR DR
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4917
Practice Address - Country:US
Practice Address - Phone:814-471-1801
Practice Address - Fax:814-472-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA117056251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health