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General NPI Number Information
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NPI Number | 1134959604
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Entity Type | Organization
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Legal Business Name | TRICARE AT INSPIRA
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Dates
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Enumeration Date | 08/07/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 825 NOAHS RD
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City | PLEASANTVILLE
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State | NJ
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Zip | 08232-4227
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Country | US
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Telephone | 609-646-1002
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Fax | 609-241-6098
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Provider Business Mailing Address
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Address Line | 165 BRIDGETON PIKE
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City | MULLICA HILL
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State | NJ
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Zip | 08062-2669
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Country | US
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Telephone | 856-641-6608
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Fax | 856-575-5029
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT & COO
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Name | WARREN E. MOORE
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Credential |
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Telephone | 856-641-6602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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