1629415732 NPI number — EAST NORRITION PHYSICIAN SERVICES

Table of content: (NPI 1629415732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629415732 NPI number — EAST NORRITION PHYSICIAN SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST NORRITION PHYSICIAN SERVICES
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:
MERCY CARDIOLOGY
Provider Other Organization Name Type Code:
3
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:
1629415732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 W ELM ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CONSHOHOCKEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19428-4108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-567-5141
Provider Business Mailing Address Fax Number:
610-567-6955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1031 S BROAD ST
Provider Second Line Business Practice Location Address:
BUILDING E
Provider Business Practice Location Address City Name:
LANSDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19446-5338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-292-6520
Provider Business Practice Location Address Fax Number:
610-292-7126
Provider Enumeration Date:
05/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
STAEDT
Authorized Official First Name:
HOPE
Authorized Official Middle Name:
Authorized Official Title or Position:
CASH-CREDENTIALING SUPERVISOR
Authorized Official Telephone Number:
610-567-5141

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com