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Organization Active NPI

Broad Street Family Health Center

Doing business as SPSI - Broad Street Family Health Center

  • Non-Pharmacy Dispensing Site
  • Marysville, PA
National Provider Identifier
1417105347
Registry record updated Dec 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
OS010593L Issued in PA
Legal business name
BROAD STREET FAMILY HEALTH CENTER
Doing business as
SPSI - Broad Street Family Health Center
Practice address
211 Broad St
Marysville, PA 17053-1302
Phone
(717) 957-3500
NPI assigned
Sep 4, 2008
Last updated
Dec 17, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 17, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kenny Heine
Title
VP of Operations
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X OS010593L PA Primary

Addresses

Primary practice location

211 Broad St
Marysville, PA 17053-1302

Mailing address

9276 Scranton Rd
Suite 100
San Diego, CA 92121-7701

Other names 1

  • SPSI - Broad Street Family Health Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Spirit Physician Services Inc21 organizations share this tax ID, including this one
Part of
Medvantx Inc

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450310400000",
    "number": "1417105347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9276 SCRANTON RD",
            "address_2": "SUITE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921217701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 BROAD ST",
            "city": "MARYSVILLE",
            "state": "PA",
            "postal_code": "170531302",
            "telephone_number": "717-957-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROAD STREET FAMILY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2008-09-04",
        "last_updated": "2015-12-17",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "PA",
            "license": "OS010593L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SPSI - Broad Street Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marysville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.