Provider Demographics
NPI:1336440700
Name:LANKENAU MEDICAL CENTER
Entity Type:Organization
Organization Name:LANKENAU MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:III
Authorized Official - Credentials:PA-C
Authorized Official - Phone:610-692-0754
Mailing Address - Street 1:514 SHARPLESS ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-3541
Mailing Address - Country:US
Mailing Address - Phone:610-692-0754
Mailing Address - Fax:
Practice Address - Street 1:100 LANCASTER AVE
Practice Address - Street 2:SUITE 418 LANKENAU MEDICAL CENTER
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:484-476-8464
Practice Address - Fax:484-476-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000079L282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital