Healthcare Provider Details

I. General information

NPI: 1093013328
Provider Name (Legal Business Name): SPIRIT PHYSICIAN SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 POPLAR CHURCH RD SUITE 400
CAMP HILL PA
17011-2203
US

IV. Provider business mailing address

205 GRANDVIEW AVE SUITE 210
CAMP HILL PA
17011-1708
US

V. Phone/Fax

Practice location:
  • Phone: 717-724-6450
  • Fax: 717-724-6451
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID GATESMAN
Title or Position: VICE PRESIDENT
Credential:
Phone: 717-972-4480