1063503977 NPI number — TOWER HEALTH MEDICAL GROUP

Table of content: (NPI 1063503977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063503977 NPI number — TOWER HEALTH MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
TOWER HEALTH MEDICAL GROUP
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:
INFECTIOUS DISEASES - TOWER HEALTH MEDICAL GROUP
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:
1063503977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/15/2008
NPI Reactivation Date:
03/27/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13579
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
READING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19612-3579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-628-0799
Provider Business Mailing Address Fax Number:
484-334-7026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 S 7TH AVE STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19611-1442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-628-4630
Provider Business Practice Location Address Fax Number:
610-374-8324
Provider Enumeration Date:
09/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CONNER
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER/VP
Authorized Official Telephone Number:
484-628-8181

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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