1275533655 NPI number — HR PHYSICIAN SERVICES

Table of content: (NPI 1275533655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275533655 NPI number — HR PHYSICIAN SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HR 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:
Provider Other Organization Name Type Code:
6
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:
1275533655
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8500 BOX #4081
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:
19178-4081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-856-1010
Provider Business Mailing Address Fax Number:
215-698-3730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23 BUSTLETON AVENUE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FEASTERVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-464-0770
Provider Business Practice Location Address Fax Number:
267-579-0720
Provider Enumeration Date:
07/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WAGNER
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT, FINANCE
Authorized Official Telephone Number:
215-856-1114

Provider Taxonomy Codes

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

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

  • Identifier: 001531340030 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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