Basic Information
| Provider Information | |||||||||
| NPI: | 1033568605 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLINICAL COLLEAGUES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 824246 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191828246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545700337 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1121 BETHLEHEM PIKE | ||||||||
| Address2: | SUTIE 60-234 | ||||||||
| City: | SPRING HOUSE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194771102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004943964 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2016 | ||||||||
| LastUpdateDate: | 08/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | GERDES | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8004943964 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CLINICAL COLLEAGUES INC | ||||||||
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| NPICertificationDate: | 08/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.