1255468435 NPI number — CITY OF PHILADELPHIA

Table of content: (NPI 1255468435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255468435 NPI number — CITY OF PHILADELPHIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF PHILADELPHIA
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:
6
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:
1255468435
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8500
Provider Second Line Business Mailing Address:
LOCKBOX #9437
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19178-9437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-686-1370
Provider Business Mailing Address Fax Number:
614-987-2075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 SPRING GARDEN 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:
19123-2923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-686-1370
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AYERS
Authorized Official First Name:
LLOYD
Authorized Official Middle Name:
Authorized Official Title or Position:
COMMISSIONER
Authorized Official Telephone Number:
215-686-1300

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  00298 , 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: 01107656 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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