Provider Demographics
NPI:1811375009
Name:HR PHYSICIAN SERVICES
Entity Type:Organization
Organization Name:HR PHYSICIAN SERVICES
Other - Org Name:HR HOUSE CALLS OF PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT, FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:R
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-856-1114
Mailing Address - Street 1:PO BOX 8500
Mailing Address - Street 2:BOX #4081
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-4081
Mailing Address - Country:US
Mailing Address - Phone:215-856-1010
Mailing Address - Fax:215-698-3730
Practice Address - Street 1:23 BUSTLETON AVENUE
Practice Address - Street 2:SUITE 200A
Practice Address - City:FEASTERVILLE
Practice Address - State:PA
Practice Address - Zip Code:19053
Practice Address - Country:US
Practice Address - Phone:215-856-1100
Practice Address - Fax:267-579-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA144456Medicare PIN