Basic Information
| Provider Information | |||||||||
| NPI: | 1104257955 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CROZER KEYSTONE URGENT CARE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PIONEER URGENT CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 OAK PARK DR | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017301414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812801699 | ||||||||
| FaxNumber: | 7812766411 | ||||||||
| Practice Location | |||||||||
| Address1: | 1572 WILMINGTON PIKE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193828371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104593278 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2013 | ||||||||
| LastUpdateDate: | 12/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | GAVIN | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6104472750 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.