1891768099 NPI number — POTTSTOWN HOSPITAL COMPANY LLC

Table of content: (NPI 1891768099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891768099 NPI number — POTTSTOWN HOSPITAL COMPANY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POTTSTOWN HOSPITAL COMPANY LLC
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:
POTTSTOWN MEMORIAL MEDICAL CENTER
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:
1891768099
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 501144
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63150-1144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 E HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POTTSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19464-5008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-327-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEWSOME
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VP, GROUP OPERATIONS
Authorized Official Telephone Number:
888-373-9600

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  163201 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007517440008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: PPA03281 . This is a "CHRONIC RENAL PROGRAM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0071403102 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 212956 . This is a "HEALTH ASSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1007517440003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1501476 . This is a "GATEWAY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 142317 . This is a "THREE RIVERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0001054000 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08301 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1007517440006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30007871 . This is a "KEYSTONE MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 128639 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 365190 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 49024 . This is a "AMERIHEALTH MERCY" identifier . This identifiers is of the category "OTHER".




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