Provider Demographics
NPI:1053374843
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:GROUP VP
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7000
Mailing Address - Street 1:1011 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9446
Mailing Address - Country:US
Mailing Address - Phone:610-869-1565
Mailing Address - Fax:610-869-0156
Practice Address - Street 1:1011 W BALTIMORE PIKE
Practice Address - Street 2:SUITE 112
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9446
Practice Address - Country:US
Practice Address - Phone:610-869-1565
Practice Address - Fax:610-869-0156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
084048Medicare ID - Type Unspecified