Provider Demographics
NPI:1982886115
Name:CHESTER COUNTY IMMEDIATE CARE PC
Entity Type:Organization
Organization Name:CHESTER COUNTY IMMEDIATE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DILIP
Authorized Official - Middle Name:K
Authorized Official - Last Name:JINDAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-269-7787
Mailing Address - Street 1:BLACK HAWK CENTER
Mailing Address - Street 2:711 EAST LANCASTER AVENUE
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335
Mailing Address - Country:US
Mailing Address - Phone:610-269-7787
Mailing Address - Fax:610-269-1099
Practice Address - Street 1:BLACK HAWK CENTER
Practice Address - Street 2:711 EAST LANCASTER AVENUE
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335
Practice Address - Country:US
Practice Address - Phone:610-269-7787
Practice Address - Fax:610-269-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433074261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA119580Medicare PIN