NPIMap

Organization Active NPI

Kenhorst Family Medical Center

  • Family Medicine Physician
  • Kenhorst, PA
National Provider Identifier
1497732572
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KENHORST FAMILY MEDICAL CENTER
Practice address
600 High Blvd
Kenhorst, PA 19607-0347
Phone
(610) 775-2799
Fax
(610) 775-3284
NPI assigned
Dec 29, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ezzat A Hanna, MDNPI 1306823489
Title
Owner
Phone
(610) 775-2799

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

600 High Blvd
Kenhorst, PA 19607-0347

Mailing address

600 High Blvd
PO Box 347
Kenhorst, PA 19607-0347
Phone (610) 775-2799

Other identifiers 2

IdentifierTypeStateIssuer
02420100OtherPACAPITAL BLUE CROSS
503515OtherPAHIGHMARK BLUE SHIELD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497732572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 HIGH BLVD",
            "address_2": "PO BOX 347",
            "city": "KENHORST",
            "state": "PA",
            "postal_code": "196070347",
            "telephone_number": "610-775-2799",
            "fax_number": "610-775-3284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 HIGH BLVD",
            "city": "KENHORST",
            "state": "PA",
            "postal_code": "196070347",
            "telephone_number": "610-775-2799",
            "fax_number": "610-775-3284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENHORST FAMILY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HANNA",
        "authorized_official_first_name": "EZZAT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-775-2799",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "02420100",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "503515",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenhorst, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.