Basic Information
| Provider Information | |||||||||
| NPI: | 1750535910 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST GROVE FAMILY PRACTICE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13579 | ||||||||
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| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196123579 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 W BALTIMORE PIKE STE 200 | ||||||||
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| City: | WEST GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193909313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108694627 | ||||||||
| FaxNumber: | 6108698407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2008 | ||||||||
| LastUpdateDate: | 11/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | EHINGER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR VP FINANCIAL OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 4846284681 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.