Provider Demographics
NPI:1023108032
Name:WASHINGTON PHYSICIAN SERVICES ORGANIZATION
Entity type:Organization
Organization Name:WASHINGTON PHYSICIAN SERVICES ORGANIZATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:300 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:COAL CENTER
Mailing Address - State:PA
Mailing Address - Zip Code:15423-1065
Mailing Address - Country:US
Mailing Address - Phone:724-938-7466
Mailing Address - Fax:724-938-7470
Practice Address - Street 1:415 3RD ST
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:PA
Practice Address - Zip Code:15419-1102
Practice Address - Country:US
Practice Address - Phone:724-938-7466
Practice Address - Fax:724-938-7470
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON HEALTH CARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-13
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA875375Medicare ID - Type Unspecified