MEDICARE: EAST NORRITON PHYSICIANS SERVICES

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1026860	OTHER	PA	KMHP
2	001	OTHER	PA	TRICARE
3	0410118001	OTHER	PA	KHPE
4	4646217	OTHER	PA	AUSHC PPO
5	482	OTHER	PA	AUSHC OFFICE NUMBER
6	586245	OTHER	PA	HIGHMARK BLUE SHIELD
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	0019374	OTHER	PA	AUSHC HMO

General Provider Information

NPI Number	:	1922091057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST NORRITON PHYSICIANS SERVICES

Provider Business Mailing Address
First Line	:	1 W ELM ST
Second Line	:	SUITE 100
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2007
Country	:	US
Telephone Number	:	610-567-6967
Fax Number	:	610-567-6955

Provider Business Practice Location Address
First Line	:	3301 RIDGE PIKE
Second Line	:
City	:	EAGLEVILLE
State	:	PA
Zip	:	19403-1411
Country	:	US
Telephone Number	:	610-539-9100
Fax Number	:	610-539-6570

Authorized Official
Title or Position	:	CFO
Name	:	MR. PETER B KENNIFF
Credential	:
Telephone Number	:	610-567-6967

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	03/11/2008

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Directions to “EAST NORRITON PHYSICIANS SERVICES ” Practice Location

Language	Start Address	Practice Location

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