Healthcare Provider Details

I. General information

NPI: 1437443041
Provider Name (Legal Business Name): WASHINGTON PHYSICIANS SERVICES ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WATERDAM PLAZA DR
MC MURRAY PA
15317-2466
US

IV. Provider business mailing address

1001 WATERDAM PLAZA DR
MC MURRAY PA
15317-2466
US

V. Phone/Fax

Practice location:
  • Phone: 724-229-1758
  • Fax: 724-229-2429
Mailing address:
  • Phone: 724-969-1001
  • Fax: 724-260-5448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD062991L
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MAUREEN SCANLON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 724-229-1756