Basic Information
| Provider Information | |||||||||
| NPI: | 1982150611 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ACTS SIGNATURE COMMUNITY SERVICES, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | PRIMARY CARE SERVICES AT FORT WASHINGTON ESTATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 375 MORRIS ROAD | ||||||||
| Address2: | |||||||||
| City: | WEST POINT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156618330 | ||||||||
| FaxNumber: | 2156618336 | ||||||||
| Practice Location | |||||||||
| Address1: | 735 SUSQUEHANNA ROAD | ||||||||
| Address2: | |||||||||
| City: | FORT WASHINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190341798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155428787 | ||||||||
| FaxNumber: | 2155427205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 09/01/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WINTER | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | V | ||||||||
| AuthorizedOfficialTelephone: | 2156618330 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.