Provider Demographics
NPI:1518056944
Name:WASHINGTON PHYSICIAN SERVICES ORGANIZATION
Entity Type:Organization
Organization Name:WASHINGTON PHYSICIAN SERVICES ORGANIZATION
Other - Org Name:WASHINGTON HEALTH SYSTEM PEDS AND ADOLESCENT CARE - WASHINGTON
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 1:100 WELLNESS WAY BLDG 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9706
Mailing Address - Country:US
Mailing Address - Phone:724-250-6001
Mailing Address - Fax:724-250-6004
Practice Address - Street 1:100 WELLNESS WAY
Practice Address - Street 2:BLDG 2
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9706
Practice Address - Country:US
Practice Address - Phone:724-250-6001
Practice Address - Fax:724-250-6004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON HEALTH CARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-12
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015918490027Medicaid