Provider Demographics
NPI:1508158973
Name:PHOENIXVILLE SPECIALTY CLINICS LLC
Entity Type:Organization
Organization Name:PHOENIXVILLE SPECIALTY CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-892-9813
Mailing Address - Street 1:824 MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4478
Mailing Address - Country:US
Mailing Address - Phone:610-933-1133
Mailing Address - Fax:
Practice Address - Street 1:420 W LINFIELD TRAPPE RD
Practice Address - Street 2:BLDG B STE 102
Practice Address - City:LIMERICK
Practice Address - State:PA
Practice Address - Zip Code:19468-4278
Practice Address - Country:US
Practice Address - Phone:610-495-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063803L332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies