Provider Demographics
NPI:1336192053
Name:SOUTHERN CHESTER COUNTY EMERGENCY ROOM ASSOCIATES PC
Entity Type:Organization
Organization Name:SOUTHERN CHESTER COUNTY EMERGENCY ROOM ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:DESIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-869-1000
Mailing Address - Street 1:PO BOX 828023
Mailing Address - Street 2:SOUTHERN CHESTER COUNTY EMERGENCY ROOM ASSOCIATES PC
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-8023
Mailing Address - Country:US
Mailing Address - Phone:610-869-1000
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:1015 W BALTIMORE PIKE
Practice Address - Street 2:JENNERSVILLE REGIONAL HOSPITAL
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9499
Practice Address - Country:US
Practice Address - Phone:610-869-1000
Practice Address - Fax:610-617-6280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001253331Medicaid
PA001253331Medicaid