Healthcare Provider Details

I. General information

NPI: 1407120942
Provider Name (Legal Business Name): SPIRIT PHYSICIAN SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N 21ST ST
CAMP HILL PA
17011-2223
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 717-972-2829
  • Fax: 717-972-2844
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

VIII. Authorized Official

Name: GERALD B OSMAN
Title or Position: VP, COO
Credential: FACHE
Phone: 717-972-4480