Healthcare Provider Details

I. General information

NPI: 1245207521
Provider Name (Legal Business Name): PRESBYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEALTH S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2006
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N 39TH ST
PHILADELPHIA PA
19104-2640
US

IV. Provider business mailing address

1500 MARKET ST UPPER MEZZENINE 600
PHILADELPHIA PA
19102-2100
US

V. Phone/Fax

Practice location:
  • Phone: 215-796-4640
  • Fax: 609-770-7792
Mailing address:
  • Phone: 215-796-4640
  • Fax: 609-770-7792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number282N00000X
License Number StatePA

VIII. Authorized Official

Name: MR. THOMAS MCCORMICK JR.
Title or Position: AVP FINANCE
Credential:
Phone: 215-762-0888