Basic Information
| Provider Information | |||||||||
| NPI: | 1770647133 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPITAL OF THE UNIVERSITY OF PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3101 MARKET ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PHILA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191042807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153495150 | ||||||||
| FaxNumber: | 2156150432 | ||||||||
| Practice Location | |||||||||
| Address1: | 3400 SPRUCE ST | ||||||||
| Address2: | |||||||||
| City: | PHILA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191044206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153495150 | ||||||||
| FaxNumber: | 2156150432 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 05/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | MCCORMICK | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSOCIATE VICE PRESIDENT FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 2156622709 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.