Basic Information
| Provider Information | |||||||||
| NPI: | 1093771271 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LANGHORNE PHYSICIAN SERVICES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LANGHORNE TRAUMA SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 UNIVERSITY DRIVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NEWTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189401873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157105522 | ||||||||
| FaxNumber: | 2157105181 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 LANGHORNE NEWTOWN RD | ||||||||
| Address2: | |||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157105092 | ||||||||
| FaxNumber: | 2157106873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 03/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | CLARKE | ||||||||
| AuthorizedOfficialFirstName: | DANIELLE | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | REGIONAL VP | ||||||||
| AuthorizedOfficialTelephone: | 2157106542 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208600000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 207RC0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1458100 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 1007497370001 | 05 | PA | MEDICAID |