Provider Demographics
NPI:1902808306
Name:EAST NORRITON PHYSICIANS SERVICES
Entity Type:Organization
Organization Name:EAST NORRITON PHYSICIANS SERVICES
Other - Org Name:MERCY INTERNAL MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:B
Authorized Official - Last Name:KENNIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-567-6967
Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2007
Mailing Address - Country:US
Mailing Address - Phone:610-567-6967
Mailing Address - Fax:610-567-6955
Practice Address - Street 1:2705 DEKALB PIKE
Practice Address - Street 2:SUITE 309
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-1852
Practice Address - Country:US
Practice Address - Phone:610-275-0200
Practice Address - Fax:610-275-4436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2228688000OtherKEYSTONE HEALTH PLAN EAST
PA1544454OtherHIGHMARK BLUE SHIELD
PA30007454OtherKEYSTONE MERCY
PA2228688001OtherKEYSTONE HEALTH PLAN EAST
PA6294024001OtherCIGNA
PA3248775OtherAUSHC HMO
PA1007594660058Medicaid
PA2228688001OtherKEYSTONE HEALTH PLAN EAST
PA1007594660058Medicaid