Provider Demographics
NPI:1891768099
Name:POTTSTOWN HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:POTTSTOWN HOSPITAL COMPANY LLC
Other - Org Name:POTTSTOWN MEMORIAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP, GROUP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-373-9600
Mailing Address - Street 1:PO BOX 501144
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-1144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 E HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5008
Practice Address - Country:US
Practice Address - Phone:610-327-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA163201282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007517440008Medicaid
PPA03281OtherCHRONIC RENAL PROGRAM
0071403102OtherAMERICHOICE
212956OtherHEALTH ASSURANCE
PA1007517440003Medicaid
1501476OtherGATEWAY
142317OtherTHREE RIVERS
0001054000OtherBCBS
08301OtherHEALTH PARTNERS
PA1007517440006Medicaid
30007871OtherKEYSTONE MERCY
128639OtherMAGELLAN
365190OtherBLACK LUNG
49024OtherAMERIHEALTH MERCY
PA1007517440003Medicaid