Active NPI
Pennsylvania Physicians Services, LLC
- Family Medicine Physician
- Paoli, PA
National Provider Identifier
1265711824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- PENNSYLVANIA PHYSICIANS SERVICES, LLC
- Practice address
- 209 W Lancaster Ave
Paoli, PA 19301-1749 - Phone
- (610) 644-2382
- Fax
- (610) 644-7517
- NPI assigned
- Aug 12, 2011
- Organization subpart
- Yes
- Parent organization
- VAXCARE CORPORATION
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Brett Kenefick
- Title
- President
- Phone
- (888) 829-8550
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
209 W Lancaster Ave
Paoli, PA 19301-1749
Mailing address
800 N Magnolia Ave Ste 700
Orlando, FL 32803-3264
Phone (888) 829-8550
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190923000158 | TX | Part B Supplier - Centralized Flu Biller | 4880924612 | Practice locations: Paoli, PA |
National Provider Directory
National Provider Directory- Part of
- Vaxcare Corporation
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
209 W Lancaster Ave
Paoli, PA 19301
Phone (610) 644-2382
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Family Medicine Physician
- Paoli, PA
- NPI 1548233083
-
- Adult Medicine Physician
- Paoli, PA
- NPI 1538185582
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313107200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1779321600000",
"number": "1265711824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 N MAGNOLIA AVE STE 700",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328033264",
"telephone_number": "888-829-8550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "209 W LANCASTER AVE",
"city": "PAOLI",
"state": "PA",
"postal_code": "193011749",
"telephone_number": "610-644-2382",
"fax_number": "610-644-7517"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PENNSYLVANIA PHYSICIANS SERVICES, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "VAXCARE CORPORATION",
"enumeration_date": "2011-08-12",
"last_updated": "2026-05-21",
"certification_date": "2026-05-21",
"status": "A",
"authorized_official_last_name": "KENEFICK",
"authorized_official_first_name": "BRETT",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "888-829-8550"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Paoli, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.