=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598134611
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DREXEL UNIVERSITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2015
-----------------------------------------------------
Last Update Date | 09/18/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 N BROAD ST 18TH FLOOR
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19102-1121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-762-7038
-----------------------------------------------------
Fax | 215-762-7015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 CHERRY ST SUITE 11511
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19102-1320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-255-7822
-----------------------------------------------------
Fax | 215-255-7825
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF BILLING OPERATIONS
-----------------------------------------------------
Name | LYNN MELADY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-255-7788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0700X
-----------------------------------------------------
Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------