Basic Information
| Provider Information | |||||||||
| NPI: | 1487960639 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPECIALTY PHYSICIAN ASSOCIATES, LLC | ||||||||
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| OtherOrganizationName: | SPA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3445 HIGH POINT BLVD. | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180177817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108665555 | ||||||||
| FaxNumber: | 6108663151 | ||||||||
| Practice Location | |||||||||
| Address1: | 3445 HIGH POINT BLVD., SUITE 400 | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180177817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108665555 | ||||||||
| FaxNumber: | 6108663151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2010 | ||||||||
| LastUpdateDate: | 02/16/2016 | ||||||||
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| AuthorizedOfficialLastName: | YEN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6108665555 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YX0602X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngic Allergy | 207Y00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.