=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942541248
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHOENIXVILLE HOSPITAL COMPANY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2013
-----------------------------------------------------
Last Update Date | 07/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 NUTT RD
-----------------------------------------------------
City | PHOENIXVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19460-3906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-983-1601
-----------------------------------------------------
Fax | 610-422-5466
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 504060
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63150-4060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-983-1601
-----------------------------------------------------
Fax | 610-422-5466
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | LAURIE HOLTSFORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-465-7466
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273Y00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital Unit
-----------------------------------------------------
License Number | 420901
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------