Organization
PENNSYLVANIA PHYSICIAN SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM H LARSEN (DIRECTOR OF CREDENTIALING)
(770) 874-5400
Entity
Organization
Contact information
Practice address
746 JEFFERSON AVE, SCRANTON, PA 18510-1624
(570) 348-7100
Mailing address
5665 NEW NORTHSIDE DR, SUITE 320, ATLANTA, GA 30328-5831
(770) 874-5400
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Enumeration date
04/27/2016
Last updated
02/05/2020
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