Provider Demographics
NPI:1174561161
Name:EAGLE HEALTH CARE LLC
Entity type:Organization
Organization Name:EAGLE HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE MANAGER/APPEALS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HUTELMYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-530-5130
Mailing Address - Street 1:PO BOX 822408
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-2408
Mailing Address - Country:US
Mailing Address - Phone:484-530-5130
Mailing Address - Fax:484-530-5135
Practice Address - Street 1:1730 WALTON ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422
Practice Address - Country:US
Practice Address - Phone:484-530-5130
Practice Address - Fax:484-530-5135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000006819332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5715760001Medicare NSC