1265529705 NPI number — CROZER-CHESTER MEDICAL CENTER

Table of content: (NPI 1265529705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265529705 NPI number — CROZER-CHESTER MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROZER-CHESTER MEDICAL CENTER
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:
CROZERTAYLORSPRINGFIELD
Provider Other Organization Name Type Code:
3
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:
1265529705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE MEDICAL CENTER BOULEVARD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPLAND
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-447-2000
Provider Business Mailing Address Fax Number:
610-619-7331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE MEDICAL CENTER BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPLAND
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-447-2000
Provider Business Practice Location Address Fax Number:
610-619-7331
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GAVIN
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
610-338-8228

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X , with the licence number:  037201 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007605830106 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135773000 . This is a "MAGELLAN DELCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1414 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001103000 . This is a "IBC/KEYSTONE HEALTH PLAN EAST/AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 87726 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 390180 . This is a "AARP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 390180 . This is a "TRICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 60019 . This is a "KEYSTONE MERCY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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