1982650594 NPI number — WJO INC.

Table of content: (NPI 1982650594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982650594 NPI number — WJO INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WJO 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:
BUSTLETON FAMILY PRACTICE AND MEDICAL CENTER
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:
1982650594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
424 MILL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRISTOL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19007-4813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-826-8050
Provider Business Mailing Address Fax Number:
215-826-8053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9600 ROOSEVELT BLVD.
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-826-8050
Provider Business Practice Location Address Fax Number:
215-826-8053
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCMANUS
Authorized Official First Name:
KRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF HUMAN RESOURCES
Authorized Official Telephone Number:
215-757-0465

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1675135 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2351050000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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