Healthcare Provider Details

I. General information

NPI: 1043401748
Provider Name (Legal Business Name): HR PHYSICIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 SECOND STREET PIKE SUITE 100
SOUTHAMPTON PA
18966-3806
US

IV. Provider business mailing address

1648 HUNTINGDON PIKE 1ST FLOOR BUSINESS OFFICE
MEADOWBROOK PA
19046-8001
US

V. Phone/Fax

Practice location:
  • Phone: 215-633-3456
  • Fax: 215-245-5941
Mailing address:
  • Phone: 215-938-2040
  • Fax: 215-938-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL R WAGNER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 215-856-1114