Healthcare Provider Details

I. General information

NPI: 1437492071
Provider Name (Legal Business Name): WASHINGTON PHYSICIAN SERVICES ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 MILLERS RUN RD
CECIL PA
15321-1403
US

IV. Provider business mailing address

98 WILSON AVE
WASHINGTON PA
15301-3335
US

V. Phone/Fax

Practice location:
  • Phone: 724-225-6500
  • Fax: 724-225-8188
Mailing address:
  • Phone: 724-229-1756
  • Fax: 724-229-2429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001591849
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICAID
# 2
Identifier875375
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICARE PTAN

VIII. Authorized Official

Name: LARRY ZIMMEL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 724-229-1756