Healthcare Provider Details

I. General information

NPI: 1447584669
Provider Name (Legal Business Name): SPIRIT PHYSICIAN SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 POPLAR CHURCH RD SUITE 210
CAMP HILL PA
17011-2250
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 717-761-7244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD041721L
License Number StatePA

VIII. Authorized Official

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