Healthcare Provider Details

I. General information

NPI: 1467626689
Provider Name (Legal Business Name): JEFFERSON UNIVERSITY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 11TH ST STE G3390
PHILADELPHIA PA
19107-4824
US

IV. Provider business mailing address

PO BOX 828937
PHILADELPHIA PA
19182-8937
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-2900
  • Fax:
Mailing address:
  • Phone: 215-503-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VALERIE BRIGHT-BUTLER
Title or Position: ASSOCIATE DIRECTOR
Credential:
Phone: 215-955-9457