Healthcare Provider Details

I. General information

NPI: 1720315765
Provider Name (Legal Business Name): FPM UROGYNECOLOGY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 HAMILTON BLVD SUITE 200
ALLENTOWN PA
18103-3628
US

IV. Provider business mailing address

3050 HAMILTON BLVD SUITE 200
ALLENTOWN PA
18103-3628
US

V. Phone/Fax

Practice location:
  • Phone: 610-435-9575
  • Fax: 610-435-2763
Mailing address:
  • Phone: 610-435-9575
  • Fax: 610-435-2763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE JARED
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 763-294-2012