Provider Demographics
NPI: | 1629009642 |
---|---|
Name: | COATESVILLE CLINIC COMPANY LLC |
Entity Type: | Organization |
Organization Name: | COATESVILLE CLINIC COMPANY LLC |
Other - Org Name: | NEUROLOGY COATESVILLE SUITE 22A TOWER HEALTH MEDICAL GROUP |
Other - Org Type: | Former Legal Business Name |
Authorized Official - Title/Position: | SR VP FINANCIAL OPERATIONS |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | EHINGER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 484-628-4681 |
Mailing Address - Street 1: | PO BOX 13579 |
Mailing Address - Street 2: | |
Mailing Address - City: | READING |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19612-3579 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 213 REECEVILLE RD |
Practice Address - Street 2: | STE 23 |
Practice Address - City: | COATESVILLE |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19320-1528 |
Practice Address - Country: | US |
Practice Address - Phone: | 610-384-6550 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-06 |
Last Update Date: | 2021-11-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
207Q00000X, 207R00000X, 207RC0000X, 207RI0011X, 207V00000X, 207X00000X, 2083X0100X, 2084P0800X, 2085R0202X, 208600000X | ||
PA | 208G00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 2083X0100X | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 1015851470003 | Medicaid | |
PA | 1872587 | Other | BCBS |
PA | 1015851470007 | Medicaid | |
PA | 1015851470009 | Medicaid | |
PA | 1848182 | Other | BCBS |
PA | 1015851470002 | Medicaid | |
PA | 1015851470010 | Medicaid | |
PA | 1846059 | Other | BCBS |
DF2119 | Medicare PIN | ||
PA | 1015851470003 | Medicaid | |
PA | 1015851470009 | Medicaid |