Provider Demographics
NPI:1386646164
Name:POTTSTOWN HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:POTTSTOWN HOSPITAL COMPANY LLC
Other - Org Name:COVENTRY MEDICAL GROUP - FP#2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEOPLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7000
Mailing Address - Street 1:730 S HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-7520
Mailing Address - Country:US
Mailing Address - Phone:610-323-6835
Mailing Address - Fax:610-323-4154
Practice Address - Street 1:193 OLD SWEDE RD
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518-1522
Practice Address - Country:US
Practice Address - Phone:610-385-3010
Practice Address - Fax:610-385-3082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007517440009Medicaid
PA71138Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER