Basic Information
| Provider Information | |||||||||
| NPI: | 1578116349 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | POTTSTOWN MEDICAL SPECIALISTS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | POTTSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194643241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103274200 | ||||||||
| FaxNumber: | 6103278160 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | POTTSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194643241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103274200 | ||||||||
| FaxNumber: | 6103278160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2019 | ||||||||
| LastUpdateDate: | 07/22/2019 | ||||||||
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| AuthorizedOfficialLastName: | KOLBMANN | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 6103274200 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | POTTSTOWN MEDICAL SPECIALISTS, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174H00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Health Educator |
No ID Information.