MEDICARE: MEDICAL SERVICE PROVIDERS LLC

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	207Q00000X	Family Medicine Physician	OS005081L	PA

General Provider Information

NPI Number	:	1730426982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL SERVICE PROVIDERS LLC

Provider Business Mailing Address
First Line	:	620 STONEBRIDGE DR
Second Line	:
City	:	SELINSGROVE
State	:	PA
Zip	:	17870-7509
Country	:	US
Telephone Number	:	570-743-1809
Fax Number	:

Provider Business Practice Location Address
First Line	:	14229 ROUTE 35
Second Line	:
City	:	RICHFIELD
State	:	PA
Zip	:	17086-8711
Country	:	US
Telephone Number	:	570-743-1809
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GENE WILLIAM REISINGER
Credential	:	DO
Telephone Number	:	570-743-1809

Provider Enumeration Date	:	01/08/2013
Last Update Date	:	01/08/2013

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