Provider Demographics
NPI:1821136227
Name:MEDICAL PROFESIONAL SERVICE, PC
Entity Type:Organization
Organization Name:MEDICAL PROFESIONAL SERVICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:570-288-4205
Mailing Address - Street 1:675 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3831
Mailing Address - Country:US
Mailing Address - Phone:570-288-4205
Mailing Address - Fax:
Practice Address - Street 1:675 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3831
Practice Address - Country:US
Practice Address - Phone:570-288-4205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty