1134297393 NPI number — METHODIST HOSPITAL

Table of content: (NPI 1134297393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134297393 NPI number — METHODIST HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METHODIST HOSPITAL
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:
1134297393
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 85009895
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19178-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-955-7106
Provider Business Mailing Address Fax Number:
215-955-8732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 SOUTH BROAD
Provider Second Line Business Practice Location Address:
BROAD AND WOLF STREETS
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-955-7106
Provider Business Practice Location Address Fax Number:
215-955-8732
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LUBARSKY
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
215-955-9895

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  200801 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0001021000 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007571300061 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6490945 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001461 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 390174 . This is a "CBH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 390174 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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