MEDICARE: WASHINGTON PHYSICIAN SERVICES ORGANIZATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1023108032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHINGTON PHYSICIAN SERVICES ORGANIZATION

Provider Business Mailing Address
First Line	:	300 TECHNOLOGY DR
Second Line	:
City	:	COAL CENTER
State	:	PA
Zip	:	15423-1065
Country	:	US
Telephone Number	:	724-938-7466
Fax Number	:	724-938-7470

Provider Business Practice Location Address
First Line	:	415 3RD ST
Second Line	:
City	:	CALIFORNIA
State	:	PA
Zip	:	15419-1102
Country	:	US
Telephone Number	:	724-938-7466
Fax Number	:	724-938-7470

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MAUREEN SCANLON
Credential	:
Telephone Number	:	724-229-1756

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	04/25/2018

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