Provider Demographics
NPI:1487743894
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 1:190 N MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4395
Mailing Address - Country:US
Mailing Address - Phone:724-225-9970
Mailing Address - Fax:724-223-4253
Practice Address - Street 1:190 N MAIN ST
Practice Address - Street 2:FLOOR 2, SUITE 204
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4349
Practice Address - Country:US
Practice Address - Phone:724-225-9970
Practice Address - Fax:724-225-2990
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON HEALTH CARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-12
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA875375Medicare ID - Type Unspecified