1649384579 NPI number — TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA

Table of content: (NPI 1649384579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649384579 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:
1649384579
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 560 W
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:
610-902-2000
Provider Business Practice Location Address Fax Number:
610-902-2040
Provider Enumeration Date:
08/18/2006

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:
215-662-7583

Provider Taxonomy Codes

  • Taxonomy code: 207QG0300X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X , 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: 1001258770 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0143087000 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 300654 . This is a "EEIOC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CN3127 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 096188 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1038558 . This is a "MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 116472401 . This is a "ACS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 25562 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 707829 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: A73600 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0002Y21509 . This is a "HEALTHNET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 273357 . This is a "MAMSI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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