Provider Demographics
NPI:1255659223
Name:WASHINGTON PHYSICIAN SERVICES ORGANIZATION
Entity Type:Organization
Organization Name:WASHINGTON PHYSICIAN SERVICES ORGANIZATION
Other - Org Name:WASHINGTON HEALTH SYSTEM INFECTIOUS DISEASE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCANLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-229-1756
Mailing Address - Street 1:95 LEONARD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3368
Mailing Address - Country:US
Mailing Address - Phone:724-206-9149
Mailing Address - Fax:724-206-9156
Practice Address - Street 1:95 LEONARD AVE STE 104
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3368
Practice Address - Country:US
Practice Address - Phone:724-229-1926
Practice Address - Fax:724-229-2937
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON HEALTH CARE SERVICE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-14
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067218L207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA875375OtherMEDICARE PTAN