1336110923 NPI number — THOMAS E MACKELL MD LTD

Table of content: (NPI 1336110923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336110923 NPI number — THOMAS E MACKELL MD LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS E MACKELL MD LTD
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:
FITNESS PHYSICAL 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:
1336110923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/01/2008
NPI Reactivation Date:
11/03/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 W STATE ST
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
DOYLESTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18901-5842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-348-3068
Provider Business Mailing Address Fax Number:
215-348-7428

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
847 EASTON RD
Provider Second Line Business Practice Location Address:
SUITE 2750
Provider Business Practice Location Address City Name:
WARRINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-918-5600
Provider Business Practice Location Address Fax Number:
215-918-5603
Provider Enumeration Date:
01/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MACKELL
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
215-348-3068

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 111202 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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