Provider Demographics
NPI:1316947799
Name:PENINSULA UNITED METHODIST HOME
Entity type:Organization
Organization Name:PENINSULA UNITED METHODIST HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXEC VP/ CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:STARCHER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:302-235-6827
Mailing Address - Street 1:726 LOVEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-1515
Mailing Address - Country:US
Mailing Address - Phone:302-235-6066
Mailing Address - Fax:302-235-6001
Practice Address - Street 1:1001 MIDDLEFORD RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3638
Practice Address - Country:US
Practice Address - Phone:302-235-6066
Practice Address - Fax:302-235-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002546207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000146180OtherPHYS SERVICES
DE154039OtherPHYS SERVICES
DE146180Medicare PIN
DE0000146180OtherPHYS SERVICES