1588657548 NPI number — EAST NORRITON PHYSICIANS SERVICES

Table of content: (NPI 1588657548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588657548 NPI number — EAST NORRITON PHYSICIANS SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST NORRITON PHYSICIANS SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MERCY FAMILY MEDICINE AT COLLEGEVILLE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588657548
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 W ELM ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CONSHOHOCKEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19428-2007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-567-6967
Provider Business Mailing Address Fax Number:
610-567-6955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 2ND AVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
COLLEGEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19426-2658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-489-2721
Provider Business Practice Location Address Fax Number:
610-489-1005
Provider Enumeration Date:
08/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KENNIFF
Authorized Official First Name:
PETER
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
610-567-6967

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0019374 . This is a "AUSHC HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 586245 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4646217 . This is a "AUSHC PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007594660054 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 022 . This is a "TRICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0410118005 . This is a "KHPE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 202264007 . This is a "OWCP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 482 . This is a "AUSHC OFFICE NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30027057 . This is a "KMHP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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