MEDICARE: UNIV OF PENN - HYPERBARIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207PH0002X	Hospice and Palliative Medicine (Emergency Medicine) Physician	PA
2	207RP1001X	Pulmonary Disease Physician	PA
3	207PE0005X	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician	PA
4	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	CF8179	OTHER	PA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07417	OTHER	PA	HEALTHPARTNERS
2	147708	OTHER	PA	BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	487202200	OTHER	PA	ACS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	0054421000	OTHER	PA	KEYSTONE
7	32901	OTHER	PA	AETNA
9	273291	OTHER	PA	MAMSI
10	0002Y21654	OTHER	PA	HEALTHNET
11	1008376	OTHER	PA	MERCY
12	203664	OTHER	PA	EEIOC

General Provider Information

NPI Number	:	1548379993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIV OF PENN - HYPERBARIC

Provider Business Mailing Address
First Line	:	3620 HAMILTON WALK
Second Line	:	1 JOHN MORGAN BUILDING
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4215
Country	:	US
Telephone Number	:	215-898-9095
Fax Number	:

Provider Business Practice Location Address
First Line	:	3620 HAMILTON WALK
Second Line	:	1 JOHN MORGAN BUILDING
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4215
Country	:	US
Telephone Number	:	215-898-9095
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ELIZABETH JOHNSTON
Credential	:
Telephone Number	:	215-662-7583

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/12/2013

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