Healthcare Provider Details

I. General information

NPI: 1588136055
Provider Name (Legal Business Name): JEFFERSON UNIVERSITY PHYSCIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 SANSOM ST FL 10
PHILADELPHIA PA
19107-5002
US

IV. Provider business mailing address

PO BOX 828937
PHILADELPHIA PA
19182-8937
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6844
  • Fax: 215-955-2526
Mailing address:
  • Phone: 215-503-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VALERIE YVETTE BRIGHT-BUTLER
Title or Position: ASSOCIATE DIRECTOR, CREDENTIALING
Credential:
Phone: 215-955-9451