Healthcare Provider Details

I. General information

NPI: 1740248905
Provider Name (Legal Business Name): TPS IV OF PA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N 15TH ST MS 310
PHILA PA
19102-1101
US

IV. Provider business mailing address

245 N 15TH ST MS 310
PHILA PA
19102-1101
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-4312
  • Fax: 215-762-8656
Mailing address:
  • Phone: 215-762-4312
  • Fax: 215-762-8656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PO CHOU
Title or Position: DIRECTOR OF FINANCE AND OPERATIONS
Credential:
Phone: 215-762-4798