Provider Demographics
NPI:1104215235
Name:PEDIATRIC SERVICES OF AMERICA, INC
Entity Type:Organization
Organization Name:PEDIATRIC SERVICES OF AMERICA, INC
Other - Org Name:PSA HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:HARMON
Authorized Official - Middle Name:
Authorized Official - Last Name:STRANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-441-1580
Mailing Address - Street 1:6 CONCOURSE PKWY
Mailing Address - Street 2:STE 1100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-6117
Mailing Address - Country:US
Mailing Address - Phone:770-248-8740
Mailing Address - Fax:770-248-8192
Practice Address - Street 1:1115 ELKTON DR
Practice Address - Street 2:STE 102
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8507
Practice Address - Country:US
Practice Address - Phone:719-548-5052
Practice Address - Fax:719-548-9209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care