Basic Information
| Provider Information | |||||||||
| NPI: | 1134212772 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CROZER-CHESTER MEDICAL CENTER | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | CROZERTAYLORSPRINGFIELD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | ONE MEDICAL CENTER BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | UPLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104472000 | ||||||||
| FaxNumber: | 6106197331 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE MEDICAL CENTER BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | UPLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104472000 | ||||||||
| FaxNumber: | 6106197331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 02/18/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GAVIN | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 6103388228 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 037201 | PA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1007605830133 | 05 | PA | MEDICAID | 1007605830140 | 05 | PA | MEDICAID | 390180 | 01 | PA | AARP | OTHER | 390180 | 01 | PA | HIP PA HEALTH PLAN | OTHER | 390180 | 01 | PA | PREFERRED CARE | OTHER | 60019 | 01 | PA | KEYSTONE MERCY HEALTH PLA | OTHER | 60019 | 01 | PA | AMERIHEALTH MERCY | OTHER | 62308 | 01 | PA | CIGNA | OTHER | 66019 | 01 | PA | HORIZON MERCY | OTHER | A151083 | 01 | DE | BLUE CROSS | OTHER | 390180 | 01 | PA | FAMILY HEALTH/NYL/ETHIX | OTHER | 390180 | 01 | PA | FIRST HEALTH AFFORDABLE | OTHER | 4197003 | 05 | NJ | MEDICAID | 86033 | 01 | PA | CIGNA MEDICARE ACCESS | OTHER | 87726 | 01 | PA | UNITED HEALTHCARE | OTHER | 0550180-03 | 01 | PA | AMERICHOICE | OTHER | 1007605830085 | 05 | PA | MEDICAID | 1007605830134 | 05 | PA | MEDICAID | 1007605830137 | 05 | PA | MEDICAID | 135773000 | 01 | PA | MAGELLAN DELCARE | OTHER | 1414 | 01 | PA | AETNA | OTHER | 390180 | 01 | PA | AMERIHEALTH DELCO | OTHER | 390180 | 01 | PA | HEALTH AMERICA/ASSURANCE | OTHER | 0001103000 | 01 | PA | BLUE CROSS IBC | OTHER | 00022 | 01 | PA | HEALTH PARTNERS | OTHER | 1007605830132 | 05 | PA | MEDICAID | 1007605830135 | 05 | PA | MEDICAID | 262460 | 01 | PA | MAMSI-OPT CHOICE MD IPA | OTHER | 390180 | 01 | PA | CARPENTERS HEALTH AND WELFARE | OTHER | 390180 | 01 | PA | TRICARE | OTHER | 390180 | 01 | PA | INTERGROUP | OTHER | 390180 | 01 | PA | MULTIPLAN | OTHER | 390180 | 01 | PA | PHCS | OTHER | 390180 | 01 | PA | PRISON SCI CHESTER | OTHER | 390180 | 01 | PA | WACHENHUT | OTHER | H06014 | 01 | PA | OXFORD | OTHER | 21552 | 01 | PA | ADVANTRA FREEDOM | OTHER | 390180 | 01 | PA | COVENTRY | OTHER | 011935100 | 05 | MD | MEDICAID | 1007605830131 | 05 | PA | MEDICAID | 1007605830138 | 05 | PA | MEDICAID | 390180 | 01 | PA | DEVON | OTHER | 390180 | 01 | PA | FIDELITY PMG | OTHER | 0000135705 | 05 | DE | MEDICAID | 0000135806 | 05 | DE | MEDICAID | 390180 | 01 | PA | GREAT WEST | OTHER | IY0107 | 01 | PA | BRAVO ELDERHEALTH | OTHER | IY0107 | 01 | PA | HEALTHNET | OTHER |