Healthcare Provider Details

I. General information

NPI: 1902110794
Provider Name (Legal Business Name): SPIRIT PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

204 MUMPER LN
DILLSBURG PA
17019-1395
US

V. Phone/Fax

Practice location:
  • Phone: 717-972-7917
  • Fax: 717-972-4470
Mailing address:
  • Phone: 717-432-2411
  • Fax: 717-432-1409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KAREN S DAVIS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 717-972-7917