Provider Demographics
NPI:1295214492
Name:MAIN LINE HEALTHCARE
Entity Type:Organization
Organization Name:MAIN LINE HEALTHCARE
Other - Org Name:MAIN LINE HEALTH URGENT CARE AND EXTENDED OUTPATIENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-337-1585
Mailing Address - Street 1:3803 W CHESTER PIKE STE 160
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2336
Mailing Address - Country:US
Mailing Address - Phone:484-337-1585
Mailing Address - Fax:484-337-1412
Practice Address - Street 1:306 E LANCASTER AVE STE 200
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:484-565-1293
Practice Address - Fax:484-476-7855
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAIN LINE HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care