1649367988 NPI number — BELMONT COURT DIALYSIS CENTER INC

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 1649367988 NPI number — BELMONT COURT DIALYSIS CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELMONT COURT DIALYSIS CENTER 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:
1649367988
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 BOULEVARD OF THE GENERALS
Provider Second Line Business Mailing Address:
HAMILTON CAMPUS
Provider Business Mailing Address City Name:
NORRISTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19403-3692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-630-1515
Provider Business Mailing Address Fax Number:
610-630-6839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 HAMILTON HEALTH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08690-3563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-689-9260
Provider Business Practice Location Address Fax Number:
609-689-9268
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAMGBOSE
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
610-630-1515

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , 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: 1035958 . This is a "HORIZON MERCY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 312552 . This is a "HORIZON BC/BS NEW JERSEY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8344108 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 550788 . This is a "AETNA US HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0001820000 . This is a "INDEPENDENCE BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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