Healthcare Provider Details

I. General information

NPI: 1780114678
Provider Name (Legal Business Name): LPP OF PENNSYLVANIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 RIDGE AVE
PHILADELPHIA PA
19128-1737
US

IV. Provider business mailing address

211 COMMERCE ST STE 800
NASHVILLE TN
37201-1817
US

V. Phone/Fax

Practice location:
  • Phone: 215-483-9900
  • Fax:
Mailing address:
  • Phone: 800-577-3886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER R KELLY
Title or Position: CHAIRMAN & CEO
Credential:
Phone: 615-554-6885