Provider Demographics
NPI:1861579203
Name:SAXON PSYCHIATRIC SERVICES P.C.
Entity type:Organization
Organization Name:SAXON PSYCHIATRIC SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAXON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-718-1996
Mailing Address - Street 1:480 PIERCE STREET
Mailing Address - Street 2:SUITE 212
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704
Mailing Address - Country:US
Mailing Address - Phone:570-718-1996
Mailing Address - Fax:570-718-1997
Practice Address - Street 1:480 PIERCE STREET
Practice Address - Street 2:SUITE 212
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704
Practice Address - Country:US
Practice Address - Phone:570-718-1996
Practice Address - Fax:570-718-1997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008157L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G43131Medicare UPIN
071011Medicare UPIN
PA875009RVTMedicare ID - Type Unspecified