Provider Demographics
NPI:1336185743
Name:PHOENIXVILLE EMERGENCY CARE SPECIALISTS, LLC
Entity Type:Organization
Organization Name:PHOENIXVILLE EMERGENCY CARE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-983-1221
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:LEDERACH
Mailing Address - State:PA
Mailing Address - Zip Code:19450-0425
Mailing Address - Country:US
Mailing Address - Phone:800-528-0006
Mailing Address - Fax:732-349-6030
Practice Address - Street 1:140 NUTT ROAD
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460
Practice Address - Country:US
Practice Address - Phone:610-983-1221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019569120001Medicaid
PA0019569120001Medicaid