1588628176 NPI number — CHESTNUT HILL EMERGENCY ASSOCIATES LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588628176 NPI number — CHESTNUT HILL EMERGENCY ASSOCIATES LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESTNUT HILL EMERGENCY ASSOCIATES LTD
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:
1588628176
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:
PO BOX 41555
Provider Second Line Business Mailing Address:
CHESTNUT HILL EMERGENCY ASSOCIATES LTD
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-777-2455
Provider Business Mailing Address Fax Number:
610-617-6280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8835 GERMANTOWN AVE
Provider Second Line Business Practice Location Address:
CHESTNUT HILL HOSPITAL
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-248-8523
Provider Business Practice Location Address Fax Number:
215-248-8275
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
ELIOT
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
215-248-8523

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 082586 . This is a "HIGHMARK BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007345170005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0060199000 . This is a "INDEPENDENCE BC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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