Basic Information
| Provider Information | |||||||||
| NPI: | 1730334244 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPIRIT PHYSICIAN SERVICES, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CENTER FOR WOMENS HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 GRANDVIEW AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | CAMP HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179724480 | ||||||||
| FaxNumber: | 7179724656 | ||||||||
| Practice Location | |||||||||
| Address1: | 423 N 21ST ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CAMP HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170112207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177639880 | ||||||||
| FaxNumber: | 7177372765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2008 | ||||||||
| LastUpdateDate: | 11/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | OSMAN | ||||||||
| AuthorizedOfficialFirstName: | GERALD | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE-PRESIDENT, COO | ||||||||
| AuthorizedOfficialTelephone: | 7179724480 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Midwife |
No ID Information.