Organization Name: | MEDICAL PROFESIONAL SERVICE, PC |
NPI Number: | 1821136227 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PHILIP JAMES MERTZ (DIRECTOR OF CLINICAL SERVICES) |
Mailing Address: | 675 Wyoming Ave Kingston |
State: | PA US |
Postal Code: | 187043831 |
Phone Number: | 5702884205 |
Fax Number: | |
NPI Enumeration Date: | 02/01/2007 |
NPI Last Update Date: | 10/22/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |