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General NPI Number Information
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NPI Number | 1104878339
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Entity Type | Organization
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Legal Business Name | EVEREST MEDICAL CARE LLC
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2010 W CHESTER PIKE SUITE 118
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City | HAVERTOWN
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State | PA
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Zip | 19083-2700
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Country | US
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Telephone | 215-200-5891
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Fax | 610-649-3658
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Provider Business Mailing Address
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Address Line | 2010 W CHESTER PIKE SUITE 118
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City | HAVERTOWN
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State | PA
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Zip | 19083-2700
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Country | US
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Telephone | 215-200-5891
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Fax | 610-649-3658
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | XIAOBIN LI
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Credential | M.D.
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Telephone | 215-200-5891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MD058825L
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License Number State | PA
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