1457349797 NPI number — NEPHROLOGY ASSOCIATES INC

Table of content: JOVAN NICOLE GILLILAND ARNP (NPI 1245653153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457349797 NPI number — NEPHROLOGY ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEPHROLOGY ASSOCIATES 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:
1457349797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E LANCASTER AVE
Provider Second Line Business Mailing Address:
SUITE 130W
Provider Business Mailing Address City Name:
WYNNEWOOD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19096-3450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-649-1175
Provider Business Mailing Address Fax Number:
610-649-2933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E LANCASTER AVE
Provider Second Line Business Practice Location Address:
SUITE 130 MEDICAL BUILDING WEST
Provider Business Practice Location Address City Name:
WYNNEWOOD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19096-3450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-649-1175
Provider Business Practice Location Address Fax Number:
610-649-2933
Provider Enumeration Date:
10/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HOVICK
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-649-1175

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0007326200002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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