1013145408 NPI number — VASCULAR MEDICINE CENTER

Table of content: (NPI 1013145408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013145408 NPI number — VASCULAR MEDICINE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASCULAR MEDICINE 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:
1013145408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
170 N HENDERSON RD
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
KING OF PRUSSIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19406-2155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-265-8700
Provider Business Mailing Address Fax Number:
610-265-1868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 N HENDERSON RD
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
KING OF PRUSSIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19406-2155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-265-8700
Provider Business Practice Location Address Fax Number:
610-265-1868
Provider Enumeration Date:
06/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SHAH
Authorized Official First Name:
MEHUL
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-265-8700

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD039894L , 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: 1000720 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4319575 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 455736/52859 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0531867000/028516000 . This is a "PERSONAL CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0531867000 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 468245 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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