1891780250 NPI number — BELMONT COURT DIALYSIS CENTER INC

Table of content: (NPI 1891780250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891780250 NPI number — BELMONT COURT DIALYSIS CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELMONT COURT DIALYSIS CENTER 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:
1891780250
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 BLVD OF THE GENERALS
Provider Second Line Business Mailing Address:
EWING CAMPUS
Provider Business Mailing Address City Name:
NORRISTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19403-3692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-630-1515
Provider Business Mailing Address Fax Number:
610-630-6839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1962 NORTH OLDEN AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EWING
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08618-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-671-1600
Provider Business Practice Location Address Fax Number:
609-671-9831
Provider Enumeration Date:
09/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BAMGBOSE
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
610-630-1515

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 312527 . This is a "HORIZON BC/BS NEW JERSEY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1035958 . This is a "HORIZON MERCY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 550788 . This is a "AETNA USHEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0001820000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 6812805 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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