Provider Demographics
NPI:1073731014
Name:MED CENTER 100
Entity Type:Organization
Organization Name:MED CENTER 100
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-903-0643
Mailing Address - Street 1:625 N. POTTSTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341
Mailing Address - Country:US
Mailing Address - Phone:610-903-0640
Mailing Address - Fax:610-903-0637
Practice Address - Street 1:625 N. POTTSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341
Practice Address - Country:US
Practice Address - Phone:610-903-0640
Practice Address - Fax:610-903-0637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA089716Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER