Basic Information
| Provider Information | |||||||||
| NPI: | 1366958274 | ||||||||
| 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: | 191824246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545700337 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 MEDICAL PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | PETERSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238059274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047655000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2017 | ||||||||
| LastUpdateDate: | 09/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | ZUMWALT | ||||||||
| AuthorizedOfficialFirstName: | KURT | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 8004943948 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.