Provider Demographics
NPI:1730426982
Name:MEDICAL SERVICE PROVIDERS LLC
Entity type:Organization
Organization Name:MEDICAL SERVICE PROVIDERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:REISINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-743-1809
Mailing Address - Street 1:620 STONEBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-7509
Mailing Address - Country:US
Mailing Address - Phone:570-743-1809
Mailing Address - Fax:
Practice Address - Street 1:14229 ROUTE 35
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:PA
Practice Address - Zip Code:17086-8711
Practice Address - Country:US
Practice Address - Phone:570-743-1809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005081L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty