Healthcare Provider Details

I. General information

NPI: 1215073507
Provider Name (Legal Business Name): CROZER-CHESTER MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MACDADE BLVD
COLLINGDALE PA
19023
US

IV. Provider business mailing address

1 MEDICAL CENTER BOULEVARD
UPLAND PA
19013-3902
US

V. Phone/Fax

Practice location:
  • Phone: 610-447-2000
  • Fax: 610-447-6620
Mailing address:
  • Phone: 610-447-2000
  • Fax: 610-447-6620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number037201
License Number StatePA

VIII. Authorized Official

Name: MR. PATRICK GAVIN
Title or Position: COO
Credential:
Phone: 610-338-8228