Basic Information
| Provider Information | |||||||||
| NPI: | 1831531672 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JASPER INPATIENT SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 WITMER RD | ||||||||
| Address2: | STE. 220 | ||||||||
| City: | HORSHAM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190442291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154425031 | ||||||||
| FaxNumber: | 2159572875 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 W 9TH ST | ||||||||
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| City: | JASPER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475462514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129960323 | ||||||||
| FaxNumber: | 8129960321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2013 | ||||||||
| LastUpdateDate: | 07/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | STONE | ||||||||
| AuthorizedOfficialFirstName: | EDDIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8005269252 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.