1750395653 NPI number — PUBLIC HEALTH MANAGEMENT CORP

Table of content: (NPI 1750395653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750395653 NPI number — PUBLIC HEALTH MANAGEMENT CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUBLIC HEALTH MANAGEMENT CORP
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:
1750395653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
260 S BROAD ST FL 18
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19102-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-985-2514
Provider Business Mailing Address Fax Number:
267-765-2325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 ADAMS AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19120-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-279-6666
Provider Business Practice Location Address Fax Number:
215-279-9674
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KILLIAN
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR-OPERATIONS
Authorized Official Telephone Number:
215-985-2514

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , 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: G001140710 . This is a "AMERICHOICE OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2287757001 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30010912 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 33926 . This is a "HEALTH PARTNERS OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001599865 . This is a "PA HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 85942 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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