Provider Demographics
NPI:1124011929
Name:EAST NORRITON PHYSICIANS SERVICES
Entity Type:Organization
Organization Name:EAST NORRITON PHYSICIANS SERVICES
Other - Org Name:BLUE BELL FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:B
Authorized Official - Last Name:KENNIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-567-6967
Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2007
Mailing Address - Country:US
Mailing Address - Phone:610-567-6967
Mailing Address - Fax:610-567-6955
Practice Address - Street 1:725 SKIPPACK PIKE
Practice Address - Street 2:PAREC PLAZA 2ND FLOOR
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1741
Practice Address - Country:US
Practice Address - Phone:215-542-1300
Practice Address - Fax:215-643-3123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30029546OtherKMHP
PA427OtherAETNA OFFICE NUMBER
PA000040925OtherHIGHMARK BLUE SHIELD
PA4422178OtherAUSHC PPO
PA1007594660064Medicaid
PA0019286OtherAUSHC HMO
PA0707702001OtherKHPE
PA202608200OtherOWCP
PA30029546OtherKMHP
PA4422178OtherAUSHC PPO