Basic Information
| Provider Information | |||||||||
| NPI: | 1568609733 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CROZER-CHESTER MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CROZERTAYLORSPRINGFIELD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE MEDICAL CENTER BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | UPLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104472000 | ||||||||
| FaxNumber: | 6104476620 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 W 9TH STREET | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190132040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104472000 | ||||||||
| FaxNumber: | 6104476620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2009 | ||||||||
| LastUpdateDate: | 01/09/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BENNETT | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | I | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 6103388228 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251J00000X | 037201 | PA | N | Agencies | Nursing Care | 282N00000X | 037201 | PA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 011935100 | 05 | PA | MEDICAID |