Healthcare Provider Details

I. General information

NPI: 1730145517
Provider Name (Legal Business Name): SPIRIT PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 BUSINESS CAMPUS WAY SUITE 200
DUNCANNON PA
17020-9596
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 717-834-3108
  • Fax: 717-834-6911
Mailing address:
  • Phone: 717-972-4480
  • Fax: 717-972-4470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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