Provider Demographics
NPI:1790038750
Name:CHS PENNSYLVANIA MEDICAL, PC
Entity Type:Organization
Organization Name:CHS PENNSYLVANIA MEDICAL, PC
Other - Org Name:ALTRIA HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-577-6601
Mailing Address - Street 1:5500 MARYLAND WAY
Mailing Address - Street 2:STE 400
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:475 N LEWIS RD
Practice Address - Street 2:
Practice Address - City:LIMERICK
Practice Address - State:PA
Practice Address - Zip Code:19468-1510
Practice Address - Country:US
Practice Address - Phone:610-792-8074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHS HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-16
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty