1376667790 NPI number — POTTSTOWN MEDICAL SPECIALISTS INC

Table of content: (NPI 1376667790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376667790 NPI number — POTTSTOWN MEDICAL SPECIALISTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POTTSTOWN MEDICAL SPECIALISTS INC
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:
SPRING FORD FAMILY PRACTICE
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:
1376667790
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1610 MEDICAL DRIVE
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
POTTSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-327-4200
Provider Business Mailing Address Fax Number:
610-327-8160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 SOUTH LEWIS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROYERSFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-792-0300
Provider Business Practice Location Address Fax Number:
610-792-3790
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ENOCHS
Authorized Official First Name:
SHANA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
610-327-4200

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OS008179L , 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: 26191 . This is a "BLUE SHIELD ASSIGN ACCT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0045725016 . This is a "KEYSTONE HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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