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General NPI Number Information
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NPI Number | 1114975869
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Entity Type | Organization
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Legal Business Name | TPS II OF PA, LLC
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 245 N BROAD ST MS 310
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City | PHILA
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State | PA
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Zip | 19107-1518
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Country | US
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Telephone | 215-762-4312
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Fax |
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Provider Business Mailing Address
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Address Line | 245 N. BROAD ST MS 310
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City | PHILA
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State | PA
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Zip | 19102
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. MICHELE HAYNES
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Credential |
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Telephone | 215-762-4312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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