1831126176 NPI number — COGENT HEALTHCARE OF PENNSYLVANIA, INC.

Table of content: (NPI 1831126176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831126176 NPI number — COGENT HEALTHCARE OF PENNSYLVANIA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COGENT HEALTHCARE OF PENNSYLVANIA, 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:
1831126176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5410 MARYLAND WAY
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-5064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-377-5670
Provider Business Mailing Address Fax Number:
615-377-1687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3401 N BROAD ST
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:
19140-5103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-377-5670
Provider Business Practice Location Address Fax Number:
615-377-1678
Provider Enumeration Date:
06/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWNIE
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
615-377-5630

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1017423290002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0870632000 . This is a "BCBS PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0870632000 . This is a "INDEPENDENCE BC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2090161 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1017423290001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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