1467720649 NPI number — RIDDLE MEMORIAL HOSPITAL

Table of content: (NPI 1467720649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467720649 NPI number — RIDDLE MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIDDLE MEMORIAL HOSPITAL
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:
RIDDLE HOSPITAL - ASC
Provider Other Organization Name Type Code:
5
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:
1467720649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 E HAVERFORD RD
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
BRYN MAWR
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19010-3850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-337-8480
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1068 W BALTIMORE PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19063-5104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-227-9400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BUONGIORNO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
484-337-8480

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  440501 , 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: 1007412290013 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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