Healthcare Provider Details

I. General information

NPI: 1760764898
Provider Name (Legal Business Name): INSPIRA MEDICAL CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 TOMLIN STATION ROAD SUITE A
MULLICA HILL NJ
08062
US

IV. Provider business mailing address

333 IRVING AVE
BRIDGETON NJ
08302-2123
US

V. Phone/Fax

Practice location:
  • Phone: 856-423-8655
  • Fax: 856-423-8675
Mailing address:
  • Phone: 856-575-4777
  • Fax: 856-575-4951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License NumberPENDING
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberPENDING
License Number StateNJ

VIII. Authorized Official

Name: MR. JOHN ALBERT DIANGELO
Title or Position: SR. VICE PRESIDENT FINANCE & CFO
Credential:
Phone: 856-641-8610