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General NPI Number Information
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NPI Number | 1982886115
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Entity Type | Organization
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Legal Business Name | CHESTER COUNTY IMMEDIATE CARE PC
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | BLACK HAWK CENTER 711 EAST LANCASTER AVENUE
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City | DOWNINGTOWN
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State | PA
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Zip | 19335
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Country | US
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Telephone | 610-269-7787
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Fax | 610-269-1099
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Provider Business Mailing Address
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Address Line | BLACK HAWK CENTER 711 EAST LANCASTER AVENUE
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City | DOWNINGTOWN
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State | PA
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Zip | 19335
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Country | US
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Telephone | 610-269-7787
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Fax | 610-269-1099
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Authorized Official
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Title or Position | DIRECTOR
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Name | DILIP K JINDAL
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Credential | M.D.
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Telephone | 610-269-7787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD433074
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License Number State | PA
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