Provider Demographics
NPI:1114340072
Name:POTTSTOWN MEMORIAL MEDICAL CENTER
Entity Type:Organization
Organization Name:POTTSTOWN MEMORIAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-2877
Mailing Address - Street 1:81 ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-6439
Mailing Address - Country:US
Mailing Address - Phone:610-970-1600
Mailing Address - Fax:
Practice Address - Street 1:81 ROBINSON ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-6439
Practice Address - Country:US
Practice Address - Phone:610-970-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POTTSTOWN CLINIC COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-29
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005383L261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy