MEDICARE: KEPHARTSPORTSMEDICINE 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	207QS0010X	Sports Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1598400392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEPHARTSPORTSMEDICINE LLC

Provider Business Mailing Address
First Line	:	403 HYDE PARK
Second Line	:
City	:	DOYLESTOWN
State	:	PA
Zip	:	18902-6619
Country	:	US
Telephone Number	:	267-406-4083
Fax Number	:	267-406-4659

Provider Business Practice Location Address
First Line	:	403 HYDE PARK
Second Line	:
City	:	DOYLESTOWN
State	:	PA
Zip	:	18902-6619
Country	:	US
Telephone Number	:	267-406-4083
Fax Number	:	267-406-4659

Authorized Official
Title or Position	:	OWNER
Name	:	ERIC M KEPHART
Credential	:	DO
Telephone Number	:	267-980-1864

Provider Enumeration Date	:	05/05/2022
Last Update Date	:	05/05/2022

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Directions to “KEPHARTSPORTSMEDICINE LLC ” Practice Location

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