1609161207 NPI number — UROLOGIC CONSULTANTS OF SOUTHEASTERN PENNSYLVANIA, LLP

Table of content: (NPI 1609161207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609161207 NPI number — UROLOGIC CONSULTANTS OF SOUTHEASTERN PENNSYLVANIA, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UROLOGIC CONSULTANTS OF SOUTHEASTERN PENNSYLVANIA, 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:
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:
1609161207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 PRESIDENTIAL BLVD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
BALA CYNWYD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19004-1017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-667-3020
Provider Business Mailing Address Fax Number:
610-667-1817

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 PRESIDENTIAL BLVD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
BALA CYNWYD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19004-1017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-667-3020
Provider Business Practice Location Address Fax Number:
610-667-1817
Provider Enumeration Date:
06/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
610-667-3020

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , 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: 110709 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DF9637 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 16408 . This is a "CIGNA-HEALTHSPRING" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1930192 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2800927000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1018621670001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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