Provider Demographics
NPI:1811927882
Name:COATESVILLE CLINIC COMPANY, LLC
Entity type:Organization
Organization Name:COATESVILLE CLINIC COMPANY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GROUP VP
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-3000
Mailing Address - Street 1:3629 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:THORNDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19372-1003
Mailing Address - Country:US
Mailing Address - Phone:610-383-1545
Mailing Address - Fax:610-383-1547
Practice Address - Street 1:3629 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:THORNDALE
Practice Address - State:PA
Practice Address - Zip Code:19372-1003
Practice Address - Country:US
Practice Address - Phone:610-383-1545
Practice Address - Fax:610-383-1547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty