Healthcare Provider Details

I. General information

NPI: 1194892471
Provider Name (Legal Business Name): TOWER HEALTH MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 11/26/2021
Certification Date: 11/26/2021
Deactivation Date: 01/09/2008
Reactivation Date: 03/26/2008

III. Provider practice location address

1220 BROADCASTING RD STE 100
WYOMISSING PA
19610-3221
US

IV. Provider business mailing address

PO BOX 13579
READING PA
19612-3579
US

V. Phone/Fax

Practice location:
  • Phone: 484-628-5673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT EHINGER
Title or Position: SR VP FINANCIAL OPERATIONS
Credential:
Phone: 484-628-1324