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Organization
POTTSTOWN MEDICAL SPECIALISTS INC
Active
Organization
POTTSTOWN MEDICAL SPECIALISTS INC
Active
Parent organization
BOYERTOWN MEDICAL ASSOCIATES
Other names
Boyertown Medical Associates
Organization subpart
Yes
Provider details
NPI number
Legal business name
BOYERTOWN MEDICAL ASSOCIATES
Authorized official
SHANA M ENOCHS (CREDENTIALING SPECIALIST)
(610) 327-4200
Entity
Organization
Contact information
Practice address
23 N. WALNUT ST, BOYERTOWN, PA 19512
(610) 367-2259
(610) 367-0505
Mailing address
23 N. WALNUT STREET, BOYERTOWN, PA 19512
(610) 367-2259
(610) 367-0505
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS008215L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0045725013
KEYSTONE HMO
PA
01
—
26191
BLUE SHIELD ASSIGN ACCT
PA
Enumeration date
03/19/2007
Last updated
07/11/2023
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