1073819967 NPI number — DELAWARE VALLEY COMMUNITY HEALTH, INC.

Table of content: (NPI 1073819967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073819967 NPI number — DELAWARE VALLEY COMMUNITY HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELAWARE VALLEY COMMUNITY HEALTH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAIRMOUNT PRIMARY CARE CENTER AT ST. JOSEPH'S HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073819967
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1412 FAIRMOUNT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19130-2908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-599-4851
Provider Business Mailing Address Fax Number:
215-232-4093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 W GIRARD AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19130-1615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-827-8010
Provider Business Practice Location Address Fax Number:
215-765-2191
Provider Enumeration Date:
02/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DEITCH
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
215-235-9600

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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