MEDICARE: CROZER KEYSTONE URGENT CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1104257955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROZER KEYSTONE URGENT CARE LLC

Provider Business Mailing Address
First Line	:	8 OAK PARK DR
Second Line	:
City	:	BEDFORD
State	:	MA
Zip	:	01730-1414
Country	:	US
Telephone Number	:	781-280-1699
Fax Number	:	781-276-6411

Provider Business Practice Location Address
First Line	:	1572 WILMINGTON PIKE
Second Line	:	SUITE 1
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-8371
Country	:	US
Telephone Number	:	610-459-3278
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PATRICK J GAVIN
Credential	:
Telephone Number	:	610-447-2750

Provider Enumeration Date	:	12/04/2013
Last Update Date	:	12/04/2013

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