Provider Demographics
NPI:1063482065
Name:COATESVILLE HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:COATESVILLE HOSPITAL CORPORATION
Other - Org Name:BRANDYWINE OB/GYN ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GROUP V.P.
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7043
Mailing Address - Street 1:330 FRANKLIN RD
Mailing Address - Street 2:135A-502
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3280
Mailing Address - Country:US
Mailing Address - Phone:610-383-6628
Mailing Address - Fax:610-383-0681
Practice Address - Street 1:217 REECEVILLE RD
Practice Address - Street 2:STE A
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-1546
Practice Address - Country:US
Practice Address - Phone:610-383-9400
Practice Address - Fax:610-383-9418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1857807Medicaid
PA1857807Medicaid