Provider Demographics
NPI:1396799417
Name:CHESPENN HEALTH SERVICES
Entity type:Organization
Organization Name:CHESPENN HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-485-3800
Mailing Address - Street 1:1510 CHESTER PIKE STE 200
Mailing Address - Street 2:
Mailing Address - City:EDDYSTONE
Mailing Address - State:PA
Mailing Address - Zip Code:19022-1377
Mailing Address - Country:US
Mailing Address - Phone:610-485-3800
Mailing Address - Fax:610-485-4221
Practice Address - Street 1:744 E LINCOLN HIGHWAY
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-3539
Practice Address - Country:US
Practice Address - Phone:610-384-5899
Practice Address - Fax:610-384-8385
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHESPENN HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-22
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007282810014Medicaid
391947Medicare ID - Type Unspecified