1134127426 NPI number — DELAWARE VALLEY MEDICAL MANAGEMENT

Table of content: (NPI 1134127426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134127426 NPI number — DELAWARE VALLEY MEDICAL MANAGEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELAWARE VALLEY MEDICAL MANAGEMENT
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:
DELAWARE VALLEY ORTHOPEDIC AND SPINE SURGICENTER
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:
1134127426
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 PRESIDENTIAL BLVD
Provider Second Line Business Mailing Address:
4TH FLOOR
Provider Business Mailing Address City Name:
BALA CYNWYD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19004-1108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-664-2122
Provider Business Mailing Address Fax Number:
610-664-2315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 PRESIDENTIAL BLVD
Provider Second Line Business Practice Location Address:
4TH FLOOR
Provider Business Practice Location Address City Name:
BALA CYNWYD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19004-1108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-664-2122
Provider Business Practice Location Address Fax Number:
610-664-2315
Provider Enumeration Date:
07/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DEBRUCE
Authorized Official First Name:
DELORES
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
610-949-7132

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  01161501 , 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: 0001596000 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 060767 . This is a "WORKER'S COMPENSATION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 060767 . This is a "MOTOR VEHICLE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0077845390002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10586 . This is a "ELDER HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2969665 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30016469 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 35243 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com