Provider Demographics
NPI:1235322983
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:VP COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-248-8757
Mailing Address - Street 1:310 TECHNOLOGY PKWY
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2932
Mailing Address - Country:US
Mailing Address - Phone:770-441-1580
Mailing Address - Fax:
Practice Address - Street 1:16 PEARL ST
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1500
Practice Address - Country:US
Practice Address - Phone:570-724-5989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03080501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health