1750696134 NPI number — RMA OF PHILADELPHIA SURGICAL CENTER LLC

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 1750696134 NPI number — RMA OF PHILADELPHIA SURGICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RMA OF PHILADELPHIA SURGICAL CENTER LLC
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:
1750696134
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
610 FREEDOM BUSINESS CTR DR STE 310
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:
19406-1329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-340-3537
Provider Business Mailing Address Fax Number:
610-337-0185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 CLARK AVE
Provider Second Line Business Practice Location Address:
SUITE 17B
Provider Business Practice Location Address City Name:
KING OF PRUSSIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-938-1515
Provider Business Practice Location Address Fax Number:
215-938-8756
Provider Enumeration Date:
08/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FREEDMAN
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-938-1515

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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