| Bridgeport Family Practice | |
|
700 Dekalb St Bridgeport PA 19405-1149 | |
| (610) 277-6200 | |
| (610) 277-3437 |
| Full Name | Bridgeport Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 700 Dekalb St, Bridgeport, Pennsylvania |
| Authorized Official Name and Position | Peter B Kenniff (CFO) |
| Authorized Official Contact | 6105676967 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridgeport Family Practice 1 W Elm St Suite 100 Conshohocken PA 19428-2007 Ph: (610) 567-6967 | Bridgeport Family Practice 700 Dekalb St Bridgeport PA 19405-1149 Ph: (610) 277-6200 |
| NPI Number | 1124012828 |
|---|---|
| Provider Enumeration Date | 09/08/2005 |
| Last Update Date | 03/11/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124012828 | NPI | - | NPPES |
| 0899194001 | Other | PA | KHPE |
| 0899194001 | Other | PA | KMHP |
| 298 | Other | PA | AUSHC OFFICE NUMBER |
| 5176213 | Other | PA | AUSHC PPO |
| 0018011 | Other | PA | AUSHC HMO |
| 1007594660059 | Medicaid | PA | |
| 852929 | Other | PA | HIGHMARK BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |