Organization
EAST NORRITON PHYSICIANS SERVICES
Active
Other names
Audubon Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER B KENNIFF (CFO)
(610) 567-6967
Entity
Organization
Contact information
Practice address
3301 RIDGE PIKE, EAGLEVILLE, PA 19403-1411
(610) 539-9100
(610) 539-6570
Mailing address
1 W ELM ST, SUITE 100, CONSHOHOCKEN, PA 19428-2007
(610) 567-6967
(610) 567-6955
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001
TRICARE
PA
01
—
0019374
AUSHC HMO
PA
01
—
0410118001
KHPE
PA
05
—
1007594660054
—
PA
01
—
1026860
KMHP
PA
01
—
4646217
AUSHC PPO
PA
01
—
482
AUSHC OFFICE NUMBER
PA
01
—
586245
HIGHMARK BLUE SHIELD
PA
Enumeration date
08/24/2005
Last updated
03/11/2008
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