Healthcare Provider Details

I. General information

NPI: 1760484737
Provider Name (Legal Business Name): HR PHYSICIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/21/2022
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648 HUNTINGDON PIKE
MEADOWBROOK PA
19046-8001
US

IV. Provider business mailing address

12265 TOWNSEND RD SUITE 500
PHILADELPHIA PA
19154-1201
US

V. Phone/Fax

Practice location:
  • Phone: 215-938-2748
  • Fax: 215-938-2966
Mailing address:
  • Phone: 215-856-1009
  • Fax: 215-856-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0015313400030
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: RUSSELL R WAGNER
Title or Position: TREASURER
Credential:
Phone: 215-856-1114