Basic Information
| Provider Information | |||||||||
| NPI: | 1902110794 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPIRIT PHYSICIAN SERVICES INC | ||||||||
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| OtherOrganizationName: | DILLSBURG FAMILY HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 MUMPER LN | ||||||||
| Address2: | |||||||||
| City: | DILLSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170191395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7174322411 | ||||||||
| FaxNumber: | 7174321409 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 GRANDVIEW AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | CAMP HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170111708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179727917 | ||||||||
| FaxNumber: | 7179724470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2010 | ||||||||
| LastUpdateDate: | 08/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 7179727917 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.