Provider Demographics
NPI:1598197824
Name:WASHINGTON PHYSICIAN SERVICES ORGANIZATION
Entity Type:Organization
Organization Name:WASHINGTON PHYSICIAN SERVICES ORGANIZATION
Other - Org Name:WASHINGTON HEALTH SYSTEM FOOT AND ANKLE SPECIALISTS
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 1:343 E ROY FURMAN HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-8084
Mailing Address - Country:US
Mailing Address - Phone:724-222-5635
Mailing Address - Fax:724-222-5638
Practice Address - Street 1:343 E ROY FURMAN HWY
Practice Address - Street 2:STE 105
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8084
Practice Address - Country:US
Practice Address - Phone:724-222-5635
Practice Address - Fax:724-222-5638
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON HEALTH CARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-09
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PW213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA875375OtherMEDICARE PTAN
PA001591849OtherMEDICAID