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NPI Code Detail

MEDICARE: SPIRIT PHYSICIAN SERVICES, INC

MEDICARE: SPIRIT PHYSICIAN SERVICES, INC
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1437115219
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPIRIT PHYSICIAN SERVICES, INC
Provider Business Mailing Address
First Line : 205 GRANDVIEW AVE
Second Line : SUITE 210
City : CAMP HILL
State : PA
Zip : 17011-1708
Country : US
Telephone Number : 717-972-4480
Fax Number :
Provider Business Practice Location Address
First Line : 211 BROAD ST
Second Line :
City : MARYSVILLE
State : PA
Zip : 17053-1302
Country : US
Telephone Number : 717-957-3500
Fax Number : 717-957-4069
Authorized Official
Title or Position : VICE-PRESIDENT
Name : DAVID GATESMAN
Credential :
Telephone Number : 717-972-4480
Provider Enumeration Date : 04/21/2006
Last Update Date : 08/24/2015

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Directions to “SPIRIT PHYSICIAN SERVICES, INC ” Practice Location

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