1588669261 NPI number — ASSOCIATED MEDICAL SPECIALTIES, INC.

Table of content: (NPI 1588669261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588669261 NPI number — ASSOCIATED MEDICAL SPECIALTIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATED MEDICAL SPECIALTIES, INC.
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:
1588669261
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2901 SOUTHAMPTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19154-1208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-677-4486
Provider Business Mailing Address Fax Number:
215-677-3644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2901 SOUTHAMPTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19154-1208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-677-4486
Provider Business Practice Location Address Fax Number:
215-677-3644
Provider Enumeration Date:
06/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BALABAN
Authorized Official First Name:
MITCHELL
Authorized Official Middle Name:
I
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
215-677-4486

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  8000000475 , 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: 0008755420002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2671433 . This is a "AETNA-HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60430 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3532909 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60430 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5986470 . This is a "AETNA-PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0875542 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 202886 . This is a "PREMIER BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202886 . This is a "PERSONAL CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2598000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000514900 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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