Healthcare Provider Details

I. General information

NPI: 1053630368
Provider Name (Legal Business Name): TPS IV OF PA., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 LINCOLN DR. WEST STE 301 4 GREENTREE CENTER
MARLTON NJ
08053-3408
US

IV. Provider business mailing address

PO BOX 827965
PHILADELPHIA PA
19182-7965
US

V. Phone/Fax

Practice location:
  • Phone: 856-396-0940
  • Fax: 856-396-0127
Mailing address:
  • Phone: 856-396-0940
  • Fax: 856-396-0127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JOHN HOLLAND
Title or Position: SVP REGIONAL OPERATIONS, TENET
Credential:
Phone: 469-893-6193