1992788350 NPI number — TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA

Table of content: (NPI 1992788350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992788350 NPI number — TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
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:
PENN HOME INFUSION THERAPY
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:
1992788350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 CLARK AVE
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
KING OF PRUSSIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19406-1438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-992-3920
Provider Business Mailing Address Fax Number:
610-265-7427

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 CLARK AVE
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
KING OF PRUSSIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19406-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-992-3920
Provider Business Practice Location Address Fax Number:
610-265-7427
Provider Enumeration Date:
11/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
REDMOND
Authorized Official First Name:
CASSANDRA
Authorized Official Middle Name:
I
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
610-992-3985

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PP414860L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: PP414860L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1001258770182 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1001258770270 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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