Basic Information
| Provider Information | |||||||||
| NPI: | 1548230469 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | POTTSTOWN HOSPITAL COMPANY LLC | ||||||||
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| OtherOrganizationName: | POTTSTOWN ONCOLOGY ASSOCIATES/POTTSTOWN OBSTETRICAL ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 689022 | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370689022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666475068 | ||||||||
| FaxNumber: | 6154652972 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 E HIGH ST | ||||||||
| Address2: | |||||||||
| City: | POTTSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194645008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103277000 | ||||||||
| FaxNumber: | 6103277432 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 01/16/2014 | ||||||||
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| AuthorizedOfficialLastName: | ARWOOD | ||||||||
| AuthorizedOfficialFirstName: | SOPHIA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6156286038 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | POTTSTOWN HOSPITAL COMPANY LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207RH0003X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 100751744 0016 | 05 | PA | MEDICAID |