1609825801 NPI number — INTENSIVIST GROUP OF PENNSYLVANIA, PC

Table of content: (NPI 1609825801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609825801 NPI number — INTENSIVIST GROUP OF PENNSYLVANIA, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTENSIVIST GROUP OF PENNSYLVANIA, PC
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:
1609825801
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT 4931
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAROL STREAM
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60122-4931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-655-2656
Provider Business Mailing Address Fax Number:
412-822-7411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 SOUTH 54TH STREET
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:
19143-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-748-9000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COWEN
Authorized Official First Name:
JAY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
800-655-2656

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1637821 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30019158 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DC3119 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2315456000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1010047220001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34928 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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