1427388511 NPI number — INSTITUTE FOR SPINAL SURGERY INC

Table of content: (NPI 1427388511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427388511 NPI number — INSTITUTE FOR SPINAL SURGERY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTE FOR SPINAL SURGERY 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:
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:
1427388511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 SPROUL RD
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
BROOMALL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19008-3509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-353-5079
Provider Business Mailing Address Fax Number:
484-427-8103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 SPROUL RD
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
BROOMALL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19008-3509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-353-5079
Provider Business Practice Location Address Fax Number:
484-427-8103
Provider Enumeration Date:
01/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FRAS
Authorized Official First Name:
CHRISTIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-353-5079

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  MD424663 , 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: 000000308051 . This is a "UNISON" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1427388511 . This is a "DELAWARE MEDICAL ASSISTANCE-DIAMOND STATE PARTNERS" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1427388511 . This is a "DELAWARE PHYSICIANS CARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 30-0419452 . This is a "MULTIPLAN" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 30-0419452 . This is a "DELAWARE WORKER'S COMPENSATION" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 30-0419452 . This is a "DEVON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3774906000 . This is a "INDEPENDENCE BLUE CROSS (PERSONAL CHOICE, KHPE, FEDERAL, AMERIHEALTH)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1427388511 . This is a "DELAWARE BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1631494 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30-0419452 . This is a "FIRST HEALTH NETWORK" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 30-0419452 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 102536817 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30-0419452 . This is a "CIGNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 30-0419452 . This is a "MULTIPLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30-0419452 . This is a "TRICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30-0419452 . This is a "DEVON HEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 30076177 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1427388511 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2522492 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 30-0419452 . This is a "FIRST HEALTH NETWORK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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