Organization
PMSI DIVISION OF GASTROENTEROLOGY
Active
Organization
PMSI DIVISION OF GASTROENTEROLOGY
Active
Parent organization
POTTSTOWN MEDICAL SPECIALISTS, INC.
Other names
POTTSTOWN MEDICAL SPECIALISTS GI
Organization subpart
Yes
Provider details
NPI number
Legal business name
POTTSTOWN MEDICAL SPECIALISTS, INC.
Authorized official
SHANA M ENOCHS (CREDENTIALING SPECIALIST)
(610) 327-4200
Entity
Organization
Contact information
Practice address
1591 MEDICAL DRIVE, POTTSTOWN, PA 19464
(610) 326-8005
(610) 326-9144
Mailing address
1610 MEDICAL DR, SUITE 310, POTTSTOWN, PA 19464
(610) 327-4200
(610) 327-8160
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
OS006112L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0860011000
KEYSTONE HMO
—
01
—
919353
BLUE SHIELD ASSIGN.ACCT
PA
Enumeration date
03/19/2007
Last updated
07/14/2016
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