1114029592 NPI number — HEALTH SERVICES OF FOX CHASE CANCER CENTER

Table of content: (NPI 1114029592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114029592 NPI number — HEALTH SERVICES OF FOX CHASE CANCER CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH SERVICES OF FOX CHASE CANCER CENTER
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:
PAIN MANAGEMENT ASSOCIATES OF FCCC
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:
1114029592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 COTTMAN AVENUE
Provider Second Line Business Mailing Address:
MEDICAL STAFF OFFICE
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-728-6900
Provider Business Mailing Address Fax Number:
215-728-3593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 COTTMAN AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-728-6900
Provider Business Practice Location Address Fax Number:
215-728-3593
Provider Enumeration Date:
09/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BECK
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
215-214-1490

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 284300000X , with the licence number: 012901 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0012467940074 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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