Penrose Medical Center, Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

MD066378L Issued in PA

Legal business name

PENROSE MEDICAL CENTER, INC

Practice address

1603 E Wadsworth Ave
Philadelphia, PA 19150-1019

Phone

(215) 242-2439

Fax

(215) 242-2596

NPI assigned

Jan 3, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Daniel P Coachi, M.D

Title

President

Phone

(215) 276-8788

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dominique Etienne, PA-C

  • Physician Assistant
  • Philadelphia, PA
  • NPI 1750710315
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447891200000",
    "number": "1417132929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1603 E WADSWORTH AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191501019",
            "telephone_number": "215-242-2439",
            "fax_number": "215-242-2596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1603 E WADSWORTH AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191501019",
            "telephone_number": "215-242-2439",
            "fax_number": "215-242-2596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENROSE MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-03",
        "last_updated": "2015-11-19",
        "status": "A",
        "authorized_official_last_name": "COACHI",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-276-8788",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "PA",
            "license": "MD066378L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017863200005",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pennwoods Home Health Care Services LLC
• Justin Penny
• Pennymed Pharmacy LLC
• Pennypack Acquisitions LLC
• Pennypack Center SNF LLC (PennyPack Nursing and Rehabilitation Center)
• Allison Marie Pensa, MD
• Deepthi Lakshmi Penta, MD
• Tirumala Lakshmi Kumari Pentakota, M.D
• Sara B Pentlicky, MD
• William H Pentz, M.D.

• Primary Care Clinic/Center in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Primary Care Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.