1508914482 NPI number — TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA

Table of content: (NPI 1508914482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508914482 NPI number — TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
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:
1508914482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3624 MARKET ST
Provider Second Line Business Mailing Address:
SUITE 560W
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19104-2614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-662-2286
Provider Business Mailing Address Fax Number:
215-615-0500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 KING OF PRUSSIA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RADNOR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19087-5220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-902-1890
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSTON
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
215-662-2286

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , 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: 1001258770262 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0222592000 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 710827 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 17599 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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