Basic Information
| Provider Information | |||||||||
| NPI: | 1336185743 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHOENIXVILLE EMERGENCY CARE SPECIALISTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 425 | ||||||||
| Address2: | |||||||||
| City: | LEDERACH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194500425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005280006 | ||||||||
| FaxNumber: | 7323496030 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 NUTT ROAD | ||||||||
| Address2: | |||||||||
| City: | PHOENIXVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109831221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 02/14/2012 | ||||||||
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| AuthorizedOfficialLastName: | HANAWAY | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6109831221 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0019569120001 | 05 | PA | MEDICAID |