Provider Demographics
NPI:1265529705
Name:CROZER-CHESTER MEDICAL CENTER
Entity type:Organization
Organization Name:CROZER-CHESTER MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-338-8228
Mailing Address - Street 1:ONE MEDICAL CENTER BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19013
Mailing Address - Country:US
Mailing Address - Phone:610-447-2000
Mailing Address - Fax:610-619-7331
Practice Address - Street 1:ONE MEDICAL CENTER BOULEVARD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013
Practice Address - Country:US
Practice Address - Phone:610-447-2000
Practice Address - Fax:610-619-7331
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROZER/TAYLOR/SPRINGFIELD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA037201273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007605830106Medicaid
PA135773000OtherMAGELLAN DELCARE
PA1414OtherAETNA
PA0001103000OtherIBC/KEYSTONE HEALTH PLAN EAST/AMERIHEALTH
PA87726OtherUNITED HEALTHCARE
PA390180OtherAARP
PA390180OtherTRICARE
PA60019OtherKEYSTONE MERCY HEALTH PLAN
PA1414OtherAETNA