Healthcare Provider Details

I. General information

NPI: 1023108032
Provider Name (Legal Business Name): WASHINGTON PHYSICIAN SERVICES ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 3RD ST
CALIFORNIA PA
15419-1102
US

IV. Provider business mailing address

300 TECHNOLOGY DR
COAL CENTER PA
15423-1065
US

V. Phone/Fax

Practice location:
  • Phone: 724-938-7466
  • Fax: 724-938-7470
Mailing address:
  • Phone: 724-938-7466
  • Fax: 724-938-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MAUREEN SCANLON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 724-229-1756