1487680500 NPI number — FKA PHC, LLP

Table of content: (NPI 1487680500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487680500 NPI number — FKA PHC, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FKA PHC, LLP
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:
1487680500
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 PULASKI DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KING OF PRUSSIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19406-2802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-768-5940
Provider Business Mailing Address Fax Number:
610-768-5947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
834 CHESTNUT ST
Provider Second Line Business Practice Location Address:
SUITE G114
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-5127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-768-5940
Provider Business Practice Location Address Fax Number:
610-768-5947
Provider Enumeration Date:
06/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KANE
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
856-465-1717

Provider Taxonomy Codes

  • Taxonomy code: 207XS0106X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0105X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251H1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0052410000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CL2877 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 171021 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P002138 . This is a "CHAMPUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 6393 . This is a "AETNA/USHC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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