=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023108032
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WASHINGTON PHYSICIAN SERVICES ORGANIZATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2006
-----------------------------------------------------
Last Update Date | 04/25/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 415 3RD ST
-----------------------------------------------------
City | CALIFORNIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15419-1102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-938-7466
-----------------------------------------------------
Fax | 724-938-7470
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 TECHNOLOGY DR
-----------------------------------------------------
City | COAL CENTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15423-1065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-938-7466
-----------------------------------------------------
Fax | 724-938-7470
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MAUREEN SCANLON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 724-229-1756
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------