Provider Demographics
NPI:1336110287
Name:WEST GROVE HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:WEST GROVE HOSPITAL COMPANY LLC
Other - Org Name:JENNERSVILLE REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP, GROUP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-373-9600
Mailing Address - Street 1:PO BOX 503773
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-3773
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1015 W BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9459
Practice Address - Country:US
Practice Address - Phone:610-869-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA291501282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000024014Medicaid
0076237003OtherAMERICHOICE
125199OtherTHREE RIVERS
0001751000OtherBCBS
PA1007312400006Medicaid
PA1007312400004Medicaid
20006033OtherAMERIHEALTH
2591247OtherUSHC HMO
2591247OtherAETNA
45391OtherKEYSTONE MERCY
DE1000024014Medicaid