Provider Demographics
NPI:1225272263
Name:CHESPENN HEALTH SERVICES
Entity Type:Organization
Organization Name:CHESPENN HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-485-3800
Mailing Address - Street 1:1510 CHESTER PIKE STE 200
Mailing Address - Street 2:
Mailing Address - City:EDDYSTONE
Mailing Address - State:PA
Mailing Address - Zip Code:19022-1377
Mailing Address - Country:US
Mailing Address - Phone:610-485-3800
Mailing Address - Fax:610-485-4221
Practice Address - Street 1:5 S STATE RD
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2013
Practice Address - Country:US
Practice Address - Phone:610-352-6585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)