1023048717 NPI number — TENET HEALTHSYSTEM GRADUATE, LLC

Table of content: (NPI 1023048717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023048717 NPI number — TENET HEALTHSYSTEM GRADUATE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENET HEALTHSYSTEM GRADUATE, LLC
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:
GRADUATE HOSPITAL
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:
1023048717
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 828120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19182-8120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-255-3152
Provider Business Mailing Address Fax Number:
215-893-2302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 LOMBARD ST
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:
19146-8400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-893-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARMIN
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
VP OF GOVT PROGRAMS, TENET
Authorized Official Telephone Number:
818-436-2267

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 073001 , 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: 000418 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15624 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: X000483602 . This is a "AMERICHOICE NEW JERSEY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01999637 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1001275950006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GRA0285N , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000017120 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11038A , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0390285 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1001275950004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37137100 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11233B , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2309 . This is a "INDEPENDENCE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3900285 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9517502 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000841822 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010055148 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60009 . This is a "KEYSTONE MERCY HEALTH PLA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 802-9709 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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