Provider Demographics
NPI:1144210584
Name:EAST NORRITON PHYSICIANS SERVICES
Entity Type:Organization
Organization Name:EAST NORRITON PHYSICIANS SERVICES
Other - Org Name:MERCY FAMILY MEDICINE AT NORRISTOWN
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:610-567-6170
Practice Address - Street 1:1437 DEKALB ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3440
Practice Address - Country:US
Practice Address - Phone:610-275-7240
Practice Address - Fax:610-275-1381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000047OtherAUSHC OFFICE NUMBER
PA2097129000OtherKHPE
PA202264000POtherOWCP
PAG001062200OtherAMERICHOICE
PADE1404878OtherHIGHMARK BLUE SHIELD
PA1007594660038Medicaid
PA1026335OtherKMHP
PA5178482OtherAUSHC PPO
PA5399OtherAUSHC HMO
PAG001062200OtherAMERICHOICE
PA1026335OtherKMHP