1881629012 NPI number — SPECTRUM HEALTH SERVICES INC

Table of content: (NPI 1881629012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881629012 NPI number — SPECTRUM HEALTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECTRUM HEALTH SERVICES 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:
1881629012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5201 HAVERFORD AVE
Provider Second Line Business Mailing Address:
SPECTRUM HEALTH SERVICES, INC
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19139-1401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-471-2761
Provider Business Mailing Address Fax Number:
215-472-6093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 W MASTER 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:
19121-4996
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-471-2761
Provider Business Practice Location Address Fax Number:
215-689-4236
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HILL-MILBOURNE
Authorized Official First Name:
VERONICA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
215-471-1267

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 091173 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1007288260005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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