=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831219518
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVIS PULMONARY ASSOCIATES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 04/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1863 CENTER ST
-----------------------------------------------------
City | CAMP HILL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17011-1703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-763-8881
-----------------------------------------------------
Fax | 717-763-9149
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1863 CENTER ST
-----------------------------------------------------
City | CAMP HILL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17011-1703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-763-8881
-----------------------------------------------------
Fax | 717-763-9149
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STEPHEN J DAVIS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 717-763-8881
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD024913E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | MD024913E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------