1841364510 NPI number — SUBURBAN PRIMARY CARE

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 1841364510 NPI number — SUBURBAN PRIMARY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUBURBAN PRIMARY CARE
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:
1841364510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3475 W CHESTER PIKE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
NEWTOWN SQUARE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19073-4280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-356-0300
Provider Business Mailing Address Fax Number:
610-356-1981

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3475 W CHESTER PIKE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
NEWTOWN SQUARE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19073-4280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-356-0300
Provider Business Practice Location Address Fax Number:
610-356-1981
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCORMICK
Authorized Official First Name:
KATIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALER
Authorized Official Telephone Number:
610-356-0300

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 085555 . This is a "AETNA ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0142949001 . This is a "KEYSTONE ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com