| |
555 Second Avenue Suite 300 Collegeville PA 19426 | |
(610) 454-7750 | |
(610) 454-1367 |
Full Name | |
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Speciality | Family Medicine |
Location | 555 Second Avenue, Collegeville, Pennsylvania |
Authorized Official Name and Position | Shana M Enochs (CREDENTIALING SPECIALIST) |
Authorized Official Contact | 6103274200 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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555 Second Avenue Suite 300 Collegeville PA 19426 Ph: (610) 454-7750 | 555 Second Avenue Suite 300 Collegeville PA 19426 Ph: (610) 454-7750 |
NPI Number | 1942324330 |
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Provider Enumeration Date | 03/19/2007 |
Last Update Date | 07/14/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1942324330 | NPI | - | NPPES |
26191 | Other | PA | BLUE SHIELD ASSIGN ACCT |
0045725015 | Other | PA | KEYSTONE HMO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | MD046620L (Pennsylvania) | Primary |
Doctor Office Management, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 409 Second Ave Ste 201, Collegeville, PA 19426 Phone: 877-366-7331 | |
Medical Care Innovation, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 400 Arcola Rd, Collegeville, PA 19426 Phone: 877-286-9798 | |
Premier Orthopaedic And Sports Medicine Associates Ltd Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 300 Springhouse Dr Ste 201, Collegeville, PA 19426 Phone: 610-489-4745 Fax: 610-482-9409 | |