Provider Demographics
NPI:1669723722
Name:ENPS MERCY PRIMARY CARE AT PLYMOUTH MEETING
Entity type:Organization
Organization Name:ENPS MERCY PRIMARY CARE AT PLYMOUTH MEETING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-567-5265
Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-4108
Mailing Address - Country:US
Mailing Address - Phone:610-567-5265
Mailing Address - Fax:610-567-6955
Practice Address - Street 1:500 W GERMANTOWN PIKE
Practice Address - Street 2:SUITE 1020
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1353
Practice Address - Country:US
Practice Address - Phone:610-941-4208
Practice Address - Fax:610-941-4158
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST NORRITON PHYSICIAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty