Provider Demographics
NPI:1669684940
Name:WEST CHESTER FAMILY PHYSICIANS INC.
Entity Type:Organization
Organization Name:WEST CHESTER FAMILY PHYSICIANS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORNWELL
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:513-779-6225
Mailing Address - Street 1:8859 BROOKSIDE CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-7113
Mailing Address - Country:US
Mailing Address - Phone:513-779-6225
Mailing Address - Fax:513-779-6905
Practice Address - Street 1:8859 BROOKSIDE CT
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-7113
Practice Address - Country:US
Practice Address - Phone:513-779-6225
Practice Address - Fax:513-779-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Q00000X207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2335628Medicaid
OH2335628Medicaid