Provider Demographics
NPI:1255859112
Name:PENN'S ROCK PRIMARY CARE
Entity Type:Organization
Organization Name:PENN'S ROCK PRIMARY CARE
Other - Org Name:PENN'S ROCK PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANSANT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:267-519-9353
Mailing Address - Street 1:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-0251
Mailing Address - Country:US
Mailing Address - Phone:215-551-0200
Mailing Address - Fax:215-551-0209
Practice Address - Street 1:801 WASHINGTON AVE UNIT C
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-4716
Practice Address - Country:US
Practice Address - Phone:267-519-9359
Practice Address - Fax:267-519-8120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-31
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010207L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty