Provider Demographics
NPI:1487699385
Name:MWGI LLC
Entity type:Organization
Organization Name:MWGI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGIEKO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:610-269-5440
Mailing Address - Street 1:150 E PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-2632
Mailing Address - Country:US
Mailing Address - Phone:610-269-5440
Mailing Address - Fax:610-269-5441
Practice Address - Street 1:150 E PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-2632
Practice Address - Country:US
Practice Address - Phone:610-269-5440
Practice Address - Fax:610-269-5441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2050261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101433Medicare PIN