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General NPI Number Information
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NPI Number | 1659179430
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Entity Type | Organization
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Legal Business Name | JEFFERSON COMMUNITY PHYSICIANS
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Dates
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Enumeration Date | 03/06/2025
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 601 WALNUT ST SUITE L50
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City | PHILADELPHIA
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State | PA
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Zip | 19106-3305
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Country | US
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Telephone | 215-409-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 MARKET ST FL 19
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City | PHILADELPHIA
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State | PA
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Zip | 19107-2926
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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 | DIRECTOR OF PROVIDER ENROLLMENT
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Name | VALERIE YVETTE BRIGHT-BUTLER
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Credential |
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Telephone | 215-955-9451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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