Provider Demographics
NPI:1578806287
Name:WASHIGNTON PHYSICIAN SERVICES ORGANIZATION
Entity Type:Organization
Organization Name:WASHIGNTON PHYSICIAN SERVICES ORGANIZATION
Other - Org Name:WASHINGTON HEALTH SYSTEM CARDIOVASCULAR CARE - WAYNESBURG
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 1:350 BONAR AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-1608
Mailing Address - Country:US
Mailing Address - Phone:724-225-6500
Mailing Address - Fax:724-229-2170
Practice Address - Street 1:350 BONAR AVE FL 3
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-1608
Practice Address - Country:US
Practice Address - Phone:724-229-1756
Practice Address - Fax:724-229-2429
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON HEALTH CARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-01
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA875375OtherMEDICARE PTAN
PA001591849OtherMEDICAID