1073600391 NPI number — BELMONT COURT DIALYSIS CENTER INC

Table of content: (NPI 1073600391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073600391 NPI number — BELMONT COURT DIALYSIS CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELMONT COURT DIALYSIS CENTER INC
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:
1073600391
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 BOULEVARD OF THE GENERALS
Provider Second Line Business Mailing Address:
ROOSEVELT
Provider Business Mailing Address City Name:
NORRISTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19403-3692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-630-1515
Provider Business Mailing Address Fax Number:
610-630-6839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6593 ROOSEVELT BLVD
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:
19149-2918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-537-6000
Provider Business Practice Location Address Fax Number:
215-537-8499
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAMGBOSE
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
610-630-1515

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , 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: 08380 . This is a "HEALTH/SENIOR PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: X000260701 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0000427000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007285120013 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50745 . This is a "AETNA US HEALTH CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PPA06037 . This is a "STATE RENAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1021750 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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