1104013085 NPI number — EAST NORRITON PHYSICIANS SERVICES

Table of content: (NPI 1104013085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104013085 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:
Provider Other Organization Name Type Code:
6
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:
1104013085
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2008
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:
19428-4108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-567-6967
Provider Business Mailing Address Fax Number:
610-567-6170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
716 W GERMANTOWN PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST NORRITON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19403-4255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-631-2159
Provider Business Practice Location Address Fax Number:
610-631-7645
Provider Enumeration Date:
09/25/2007

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:
610-631-2159

Provider Taxonomy Codes

  • Taxonomy code: 207QS0010X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2097129000 . This is a "KHPE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1026335 . This is a "KMHP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5178482 . This is a "AUSHC PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5399 . This is a "AUSHC HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DE1404878 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 100759466 0038 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 202264000 . This is a "OWCP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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