Organization
MAXIS MEDICAL SERVICES
Active
Other names
pediatric care
Organization subpart
No
Provider details
NPI number
Authorized official
MARY THERESA VAUTRINOT (CEO)
(570) 281-1001
Entity
Organization
Contact information
Practice address
42 N SCOTT ST, CARBONDALE, PA 18407-1888
(570) 282-6660
Mailing address
PO BOX 517, CARBONDALE, PA 18407-0517
(570) 281-1287
(570) 281-1256
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
887913
BLUE SHIELD
PA
Enumeration date
02/14/2007
Last updated
08/22/2020
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