Provider Demographics
NPI:1528403649
Name:SPIRIT PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:SPIRIT PHYSICIAN SERVICES, INC.
Other - Org Name:HOLY SPIRIT FAMILY MEDICINE COLONIAL PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GATESMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-972-7917
Mailing Address - Street 1:205 GRANDVIEW AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1708
Mailing Address - Country:US
Mailing Address - Phone:717-972-7917
Mailing Address - Fax:
Practice Address - Street 1:4230 CRUMS MILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2898
Practice Address - Country:US
Practice Address - Phone:717-233-6171
Practice Address - Fax:717-231-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD454073207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty