Provider Demographics
NPI:1134339161
Name:VILLAGE SHIRES FAMILY MEDICINE
Entity type:Organization
Organization Name:VILLAGE SHIRES FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-497-1001
Mailing Address - Street 1:1496 BUCK RD STE A6
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-2626
Mailing Address - Country:US
Mailing Address - Phone:215-497-1001
Mailing Address - Fax:
Practice Address - Street 1:1496 BUCK RD STE A6
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:18966-2626
Practice Address - Country:US
Practice Address - Phone:215-497-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008256L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2637013000OtherPERSONAL CHOICE
3000425OtherKEYSTONE MERCY
PA1590387Medicaid
2637013001OtherKEYSTONE
590387OtherAMERICHOICE
2015082OtherAETNA
1795896OtherHORIZON
1795896OtherHORIZON
PA098691Medicare ID - Type Unspecified