Maxis Medical Services

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MAXIS MEDICAL SERVICES

Doing business as

Family Medical Center

Practice address

263 Carbondale Rd
Waymart, PA 18472-9113

Phone

(570) 488-5544

NPI assigned

Feb 6, 2007

Last updated

Sep 27, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mary Theresa Vautrinot

Title

Ceo

Phone

(570) 281-1315

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• FAMILY MEDICAL CENTER Doing business as

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190851200000",
    "number": "1659410504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 517",
            "city": "CARBONDALE",
            "state": "PA",
            "postal_code": "184070517",
            "telephone_number": "570-281-1287",
            "fax_number": "570-281-1256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 CARBONDALE RD",
            "city": "WAYMART",
            "state": "PA",
            "postal_code": "184729113",
            "telephone_number": "570-488-5544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXIS MEDICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2007-09-27",
        "status": "A",
        "authorized_official_last_name": "VAUTRINOT",
        "authorized_official_first_name": "MARY THERESA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "570-281-1315"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PENNA BLUE SHIELD",
            "identifier": "1467916",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amanda L Kisel, MS, LBS, LSW
• Amanda Knickerbocker, LPC
• Marci Ann Kowalewski, PAC
• Kathleen Marie Lello
• Michelle Marie Marcho, PTA
• Mogerman Jason Orthopaedic Institute,LLC
• Jeffrey A Mogerman, MD
• Allen J Orehek, MD
• Katherine Orehek
• Pediatric Practices of Northeastern PA

• Family Medicine Physician in Waymart, PA
• Providers in Waymart, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2007; 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.