1194183822 NPI number — SPIRIT PHYSICIAN SERVICES, INC

Table of content: (NPI 1194183822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194183822 NPI number — SPIRIT PHYSICIAN SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPIRIT PHYSICIAN SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194183822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 GRANDVIEW AVE
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
CAMP HILL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17011-1708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-972-4480
Provider Business Mailing Address Fax Number:
717-972-4156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 ERFORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORMLEYSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17043-1163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-763-3008
Provider Business Practice Location Address Fax Number:
717-972-6865
Provider Enumeration Date:
02/09/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GATESMAN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
VICE -PRESIDENT
Authorized Official Telephone Number:
717-972-4480

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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