Basic Information
| Provider Information | |||||||||
| NPI: | 1770549552 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPIRIT PHYSICIAN SERVICES INC | ||||||||
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| OtherOrganizationName: | DEVONSHIRE FAMILY HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 GRANDVIEW AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | CAMP HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170111708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179724480 | ||||||||
| FaxNumber: | 7179724470 | ||||||||
| Practice Location | |||||||||
| Address1: | 4300 DEVONSHIRE RD | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171091540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179724480 | ||||||||
| FaxNumber: | 7179724470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | OSMAN | ||||||||
| AuthorizedOfficialFirstName: | GERALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 7179724480 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.