Provider Demographics
NPI:1053318261
Name:PENINSULA UNITED METHODIST HOMES
Entity Type:Organization
Organization Name:PENINSULA UNITED METHODIST HOMES
Other - Org Name:METHODIST COUNTRY HOUSE PHYS SVCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC VP/ CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:STARCHER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:302-235-6066
Mailing Address - Street 1:726 LOVEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-1515
Mailing Address - Country:US
Mailing Address - Phone:302-235-6066
Mailing Address - Fax:302-235-6001
Practice Address - Street 1:4830 KENNETT PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19807-1866
Practice Address - Country:US
Practice Address - Phone:302-235-6066
Practice Address - Fax:302-235-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002836207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE51008217WOtherPHYSICIAN SERVICES
DE183642Medicare PIN
DE51008217WOtherPHYSICIAN SERVICES