Provider Demographics
NPI:1598400392
Name:KEPHARTSPORTSMEDICINE LLC
Entity Type:Organization
Organization Name:KEPHARTSPORTSMEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:KEPHART
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:267-980-1864
Mailing Address - Street 1:403 HYDE PARK
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18902-6619
Mailing Address - Country:US
Mailing Address - Phone:267-406-4083
Mailing Address - Fax:267-406-4659
Practice Address - Street 1:403 HYDE PARK
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18902-6619
Practice Address - Country:US
Practice Address - Phone:267-406-4083
Practice Address - Fax:267-406-4659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty