Provider Demographics
NPI:1659626224
Name:SPIRIT PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:SPIRIT PHYSICIAN SERVICES, INC.
Other - Org Name:SPIRIT UGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, 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:FACHE
Authorized Official - Phone:717-972-4480
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:
Mailing Address - Fax:
Practice Address - Street 1:431 N 21ST ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2202
Practice Address - Country:US
Practice Address - Phone:717-763-3730
Practice Address - Fax:717-763-3731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty