Provider Demographics
NPI:1982860862
Name:CHESTER SPRINGS FAMILY PRACTICE, LLC
Entity Type:Organization
Organization Name:CHESTER SPRINGS FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:OUATTARA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-321-1940
Mailing Address - Street 1:662 WHARTON BLVD
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1188
Mailing Address - Country:US
Mailing Address - Phone:610-321-1940
Mailing Address - Fax:610-471-0454
Practice Address - Street 1:662 WHARTON BLVD
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1188
Practice Address - Country:US
Practice Address - Phone:610-321-1940
Practice Address - Fax:610-471-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012561261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101061531Medicaid
PA101061531Medicaid
PAIO3486Medicare UPIN