1093948820 NPI number — WASHINGTON PHYSICIAN SERVICES ORGANIZATION

Table of content: (NPI 1093948820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093948820 NPI number — WASHINGTON PHYSICIAN SERVICES ORGANIZATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON PHYSICIAN SERVICES ORGANIZATION
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:
6
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:
1093948820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 LEONARD AVE STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15301-3368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-579-1075
Provider Business Mailing Address Fax Number:
724-249-2833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95 LEONARD AVE
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15301-3368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-579-1075
Provider Business Practice Location Address Fax Number:
724-249-2833
Provider Enumeration Date:
08/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SCANLON
Authorized Official First Name:
MAUREEN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
724-229-1756

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  MD047902L , 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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