Basic Information
| Provider Information | |||||||||
| NPI: | 1558367250 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POMPER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8500-1776 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191780001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018042800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 111 S 11TH ST # 8490 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159556161 | ||||||||
| FaxNumber: | 2159235507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 03/13/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN-246719-L | PA | N | Nursing Service Providers | Registered Nurse | 367500000X | 038533 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 84347 | 01 | PA | GEISINGER | OTHER | 0448668 | 01 | PA | FIRST PRIORITY | OTHER | 50026737 | 01 | PA | CAPITAL ADVANTAGE | OTHER | 728009000 | 01 | PA | IBC | OTHER | 0448668 | 01 | PA | HIGHMARK | OTHER | 2000104 | 01 | PA | KHP CENTRAL | OTHER | 1585157 | 01 | PA | GATEWAY | OTHER | 9532437 | 01 | PA | AETNA | OTHER |