Healthcare Provider Details

I. General information

NPI: 1831213321
Provider Name (Legal Business Name): POTTSTOWN MEDICAL SPECIALISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 MEDICAL DR STE B
POTTSTOWN PA
19464-3241
US

IV. Provider business mailing address

1601 MEDICAL DR STE B
POTTSTOWN PA
19464-3241
US

V. Phone/Fax

Practice location:
  • Phone: 484-945-0111
  • Fax: 484-945-0122
Mailing address:
  • Phone: 484-945-0111
  • Fax: 484-945-0122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMD042011E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY CLARE SLIFER
Title or Position: CEO
Credential:
Phone: 610-327-4200