Basic Information
| Provider Information | |||||||||
| NPI: | 1912192337 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCHUYLKILL INTERNAL MEDICINE ASSOCIATES LLC | ||||||||
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| OtherOrganizationName: | FAMILY MEDICINE COLLEGEVILLE TOWER HEALTH MEDICAL GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7100 COMMERCE WAY | ||||||||
| Address2: | STE 180 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370272829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154657000 | ||||||||
| FaxNumber: | 6154653007 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 SECOND AVE STE D-201 | ||||||||
| Address2: | |||||||||
| City: | COLLEGEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194263642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108312280 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2007 | ||||||||
| LastUpdateDate: | 11/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | EHINGER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR VP FINANCIAL OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 4846284681 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.