| Sovereign Family Practice Inc | |
|
7150 Hamilton Blvd Unit 400 Trexlertown PA 18087-9734 | |
| (610) 351-1555 | |
| (610) 351-1445 |
| Full Name | Sovereign Family Practice Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7150 Hamilton Blvd Unit 400, Trexlertown, Pennsylvania |
| Authorized Official Name and Position | Gillian Odonnell Morse (CEO) |
| Authorized Official Contact | 2672261181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sovereign Family Practice Inc 7150 Hamilton Blvd Unit 400 Trexlertown PA 18087-9734 Ph: (610) 351-1555 | Sovereign Family Practice Inc 7150 Hamilton Blvd Unit 400 Trexlertown PA 18087-9734 Ph: (610) 351-1555 |
| NPI Number | 1316686702 |
|---|---|
| Provider Enumeration Date | 06/02/2022 |
| Last Update Date | 06/02/2022 |
| Medicare PECOS PAC ID | 2062883481 |
|---|---|
| Medicare Enrollment ID | O20230123002827 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316686702 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Mark A Bruno |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1295706604 PECOS PAC ID: 4688779622 Enrollment ID: I20070419000194 |
| Provider Name | Izabela Dzimira |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679235063 PECOS PAC ID: 4688047368 Enrollment ID: I20230228000631 |
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