Provider Demographics
NPI:1174816227
Name:RENAISSANCE MEDICAL MANAGEMENT COMPANY
Entity Type:Organization
Organization Name:RENAISSANCE MEDICAL MANAGEMENT COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-254-2955
Mailing Address - Street 1:489 DEVON PARK DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1809
Mailing Address - Country:US
Mailing Address - Phone:610-254-7662
Mailing Address - Fax:610-687-8458
Practice Address - Street 1:489 DEVON PARK DR
Practice Address - Street 2:SUITE 306
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1809
Practice Address - Country:US
Practice Address - Phone:610-254-7662
Practice Address - Fax:610-687-8458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty