Provider Demographics
NPI:1093849366
Name:FLEET MEDICAL INC
Entity type:Organization
Organization Name:FLEET MEDICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-827-1539
Mailing Address - Street 1:24 LAUREN LANE
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425
Mailing Address - Country:US
Mailing Address - Phone:610-827-1539
Mailing Address - Fax:610-941-7155
Practice Address - Street 1:3206 WOODVIEW WAY
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3233
Practice Address - Country:US
Practice Address - Phone:610-827-1539
Practice Address - Fax:610-941-7155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty