Provider Demographics
NPI:1558892570
Name:NAZARETH PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:NAZARETH PHYSICIAN SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. REGIONAL PRAC. OPS.
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HILKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-597-5529
Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-4108
Mailing Address - Country:US
Mailing Address - Phone:610-567-5387
Mailing Address - Fax:
Practice Address - Street 1:2701 HOLME AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2029
Practice Address - Country:US
Practice Address - Phone:610-567-5387
Practice Address - Fax:610-567-5420
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAZARETH PHYSICIAN SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-22
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA095918Medicare PIN