Provider Demographics
NPI:1063407096
Name:WEST GROVE HOSPITAL CORPORATION
Entity type:Organization
Organization Name:WEST GROVE HOSPITAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUONOMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-998-1700
Mailing Address - Street 1:121 BELL TOWER LN
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19363-1208
Mailing Address - Country:US
Mailing Address - Phone:610-998-1700
Mailing Address - Fax:610-998-1799
Practice Address - Street 1:121 BELL TOWER LN
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:PA
Practice Address - Zip Code:19363-1208
Practice Address - Country:US
Practice Address - Phone:610-998-1700
Practice Address - Fax:610-998-1799
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST GROVE HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA740005251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA58150671002OtherTRICARE PROV #
PA0000804000OtherBLUE CROSS PROVIDER #
PA1007312400008Medicaid
PA1152927OtherKEYSTONE MERCY HEALTH PLA
PA=========OtherAETNA
PA0000804000OtherBLUE CROSS PROVIDER #