Provider Demographics
NPI:1578716056
Name:POTTSTOWN MEDICAL SPECIALISTS, INC.
Entity Type:Organization
Organization Name:POTTSTOWN MEDICAL SPECIALISTS, INC.
Other - Org Name:PMSI PAIN MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER & AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KENNEDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SBAT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-327-4200
Mailing Address - Street 1:1610 MEDICAL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3292
Mailing Address - Country:US
Mailing Address - Phone:484-945-0405
Mailing Address - Fax:484-945-0379
Practice Address - Street 1:1610 MEDICAL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3292
Practice Address - Country:US
Practice Address - Phone:484-945-0405
Practice Address - Fax:484-945-0379
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POTTSTOWN MEDICAL SPECIALISTS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-29
Last Update Date:2019-03-29
Deactivation Date:2017-10-20
Deactivation Code:
Reactivation Date:2019-03-29
Provider Licenses
StateLicense IDTaxonomies
PAMD4188702081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA026191D8PMedicare PIN