Organization
PHOENIXVILLE SPECIALTY CLINICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUIS ROSA (VP PAYOR CONTRACTING)
(484) 628-2099
Entity
Organization
Contact information
Practice address
824 MAIN ST STE 306, PHOENIXVILLE, PA 19460-4478
(610) 933-1133
(610) 933-4238
Mailing address
4000 MERIDIAN BLVD, FRANKLIN, TN 37067-6325
(615) 465-7000
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
—
—
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1017628220001
—
PA
Enumeration date
10/13/2006
Last updated
05/09/2019
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