1811064959 NPI number — RIDGAWAY PHILIPS OF DE, INC

Table of content: (NPI 1811064959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811064959 NPI number — RIDGAWAY PHILIPS OF DE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIDGAWAY PHILIPS OF DE, 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:
1811064959
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
908 CHURCHMANS ROAD EXT
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
NEW CASTLE
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19720-3109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-323-1436
Provider Business Mailing Address Fax Number:
302-323-1481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
908 CHURCHMANS ROAD EXT
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19720-3109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-323-1436
Provider Business Practice Location Address Fax Number:
302-323-1481
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-643-1200

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  2003109630 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0001987000 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001987000 . This is a "AMERIHEALTH HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 157A46 . This is a "BC BS OF DE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 201484 . This is a "COVENTRY HEALTH CARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0001990000 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1000024008 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1526 . This is a "GENTIVA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4492440 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1000033612 . This is a "DE PHYSICIANS CARE, INC" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 3333942 . This is a "AETNA LIFE INS, CO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5701000157A460 . This is a "INDEPENDENT LICENSE BC BS" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0001989000 . This is a "KEYSTONE HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001990000 . This is a "KEYSTONE HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001987000 . This is a "KEYSTONE HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001989000 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001989000 . This is a "AMERIHEALTH HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001990000 . This is a "AMERIHEALTH HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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