MEDICARE: EASTWICK PRIMARY CARE

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	261QP2300X	Primary Care Clinic/Center	MD024544L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	144292	OTHER	PA	BS

General Provider Information

NPI Number	:	1760580773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTWICK PRIMARY CARE

Provider Business Mailing Address
First Line	:	2801 ISLAND AVE
Second Line	:	SUITE 10 11
City	:	PHILA
State	:	PA
Zip	:	19153-2326
Country	:	US
Telephone Number	:	215-492-8800
Fax Number	:	215-492-6421

Provider Business Practice Location Address
First Line	:	2801 ISLAND RD
Second Line	:	SUITE 10 11
City	:	PHILA
State	:	PA
Zip	:	19153-2326
Country	:	US
Telephone Number	:	215-492-8800
Fax Number	:	215-492-6421

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. JOYCE M FOX
Credential	:	OFFICE MANAGER
Telephone Number	:	215-492-8800

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	05/11/2011

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Directions to “EASTWICK PRIMARY CARE ” Practice Location

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