1295817435 NPI number — WILLS SURGERY CENTER OF CHERRY HILL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295817435 NPI number — WILLS SURGERY CENTER OF CHERRY HILL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLS SURGERY CENTER OF CHERRY HILL
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:
1295817435
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
408 MARLTON PIKE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08034-2409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-354-1600
Provider Business Mailing Address Fax Number:
856-429-7555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 MARLTON PIKE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08034-2409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-354-1600
Provider Business Practice Location Address Fax Number:
856-429-7555
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BILSON
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-440-3152

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  10287 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10287 . This is a "LICENSE #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1016702 . This is a "HORIZON MERCY PROVIDER #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 526637 . This is a "AETNA/USHC PROVIDER #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0001375000 . This is a "AMERIHEALTH PROVIDER #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 490002850 . This is a "MEDICARE RAILROAD PROVIDE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6735100 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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