MEDICARE: SPIRIT PHYSICIAN SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1174631824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPIRIT PHYSICIAN SERVICES INC

Provider Business Mailing Address
First Line	:	205 GRANDVIEW AVE
Second Line	:	SUITE210
City	:	CAMP HILL
State	:	PA
Zip	:	17011-1708
Country	:	US
Telephone Number	:	717-972-4480
Fax Number	:	717-972-4470

Provider Business Practice Location Address
First Line	:	205 GRANDVIEW AVE
Second Line	:	SUITE210
City	:	CAMP HILL
State	:	PA
Zip	:	17011-1708
Country	:	US
Telephone Number	:	717-972-4480
Fax Number	:	717-972-4470

Authorized Official
Title or Position	:	CEO
Name	:	GERALD OSMAN
Credential	:
Telephone Number	:	717-972-4480

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	08/22/2020

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Directions to “SPIRIT PHYSICIAN SERVICES INC ” Practice Location

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