1982768362 NPI number — SPINAL CARE PAIN ASSOCIATES P C

Table of content: (NPI 1982768362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982768362 NPI number — SPINAL CARE PAIN ASSOCIATES P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPINAL CARE PAIN ASSOCIATES P C
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:
6
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:
1982768362
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:
2410 S BROAD ST
Provider Second Line Business Mailing Address:
3RD FLR
Provider Business Mailing Address City Name:
PHILA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19145-4418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-462-6600
Provider Business Mailing Address Fax Number:
215-462-2650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2410 S BROAD ST
Provider Second Line Business Practice Location Address:
3RD FLR
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19145-4418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-462-6600
Provider Business Practice Location Address Fax Number:
215-462-2650
Provider Enumeration Date:
12/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEISS
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
215-462-6600

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2133384000 . This is a "ALL IBC PRODUCTS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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