Provider Demographics
NPI:1457309536
Name:COATESVILLE CLINIC COMPANY, LLC
Entity Type:Organization
Organization Name:COATESVILLE CLINIC COMPANY, LLC
Other - Org Name:OAKLANDS FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GROUP VP
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-524-4106
Mailing Address - Street 1:460 CREAMERY WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2533
Mailing Address - Country:US
Mailing Address - Phone:610-524-4106
Mailing Address - Fax:610-524-4168
Practice Address - Street 1:460 CREAMERY WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2533
Practice Address - Country:US
Practice Address - Phone:610-524-4106
Practice Address - Fax:610-524-4168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherTAX ID