1215073507 NPI number — CROZER-CHESTER MEDICAL CENTER

Table of content: (NPI 1215073507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215073507 NPI number — CROZER-CHESTER MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROZER-CHESTER MEDICAL 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:
Provider Other Organization Name Type Code:
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:
1215073507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MEDICAL CENTER BOULEVARD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPLAND
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19013-3902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-447-2000
Provider Business Mailing Address Fax Number:
610-447-6620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 MACDADE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLINGDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-447-2000
Provider Business Practice Location Address Fax Number:
610-447-6620
Provider Enumeration Date:
01/30/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GAVIN
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
610-338-8228

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  037201 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 349217000 . This is a "MAGELLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 10076058329 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".