Healthcare Provider Details

I. General information

NPI: 1023048717
Provider Name (Legal Business Name): TENET HEALTHSYSTEM GRADUATE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 LOMBARD ST
PHILADELPHIA PA
19146-8400
US

IV. Provider business mailing address

PO BOX 828120
PHILADELPHIA PA
19182-8120
US

V. Phone/Fax

Practice location:
  • Phone: 215-893-2000
  • Fax:
Mailing address:
  • Phone: 215-255-3152
  • Fax: 215-893-2302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number073001
License Number StatePA

VIII. Authorized Official

Name: MR. CRAIG C. ARMIN
Title or Position: VP OF GOVT PROGRAMS, TENET
Credential:
Phone: 818-436-2267