Provider Demographics
NPI:1972028272
Name:ON SITE MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:ON SITE MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENHOWER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-233-9842
Mailing Address - Street 1:500 WILLIAM EBBS LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-5210
Mailing Address - Country:US
Mailing Address - Phone:215-233-9842
Mailing Address - Fax:215-233-9488
Practice Address - Street 1:500 WILLIAM EBBS LN
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-5210
Practice Address - Country:US
Practice Address - Phone:215-233-9842
Practice Address - Fax:215-233-9488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421472207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty