MEDICARE: NE 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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CH4674	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0097905000	OTHER	PA	PERSONAL CHOICE
3	30000255	OTHER	PA	KEYSTONE MERCY
4	405091	OTHER	PA	BS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518923036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NE PHYSICIAN SERVICES INC

Provider Business Mailing Address
First Line	:	3542 WELSH RD
Second Line	:	NE PHYSICIAN SERVICES INC
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-2623
Country	:	US
Telephone Number	:	215-333-6888
Fax Number	:	215-333-3945

Provider Business Practice Location Address
First Line	:	3542 WELSH RD
Second Line	:	NE PHYSICIAN SERVICES INC
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-2623
Country	:	US
Telephone Number	:	215-333-6888
Fax Number	:	215-333-3945

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. STANLEY T DEPMAN
Credential	:	MD
Telephone Number	:	215-333-6888

Provider Enumeration Date	:	04/24/2006
Last Update Date	:	09/06/2007

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Directions to “NE PHYSICIAN SERVICES INC ” Practice Location

Language	Start Address	Practice Location

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