Healthcare Provider Details

I. General information

NPI: 1447250386
Provider Name (Legal Business Name): SPRUCE MRI ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SPRUCE ST
PHILADELPHIA PA
19107-5701
US

IV. Provider business mailing address

510 WALNUT ST STE 420
PHILADELPHIA PA
19106-3601
US

V. Phone/Fax

Practice location:
  • Phone: 610-459-3113
  • Fax:
Mailing address:
  • Phone: 610-459-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: DOMINIC CHILA
Title or Position: OFFICE MANAGER
Credential:
Phone: 610-459-3113