Provider Demographics
NPI:1558506261
Name:SPIRIT PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:SPIRIT PHYSICIAN SERVICES, INC.
Other - Org Name:BROAD STREET FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT - COO
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:OSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-972-4480
Mailing Address - Street 1:211 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17053-1302
Mailing Address - Country:US
Mailing Address - Phone:717-957-3500
Mailing Address - Fax:717-957-4069
Practice Address - Street 1:211 BROAD ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17053-1302
Practice Address - Country:US
Practice Address - Phone:717-957-3500
Practice Address - Fax:717-957-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty