=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699926071
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHEYNEY UNIVERSITY OF PENNSYLVANIA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2008
-----------------------------------------------------
Last Update Date | 10/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 740 CHEYNEY RD ROGERS & MCKNIGHT BUILDING
-----------------------------------------------------
City | CHEYNEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19319-1018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-399-2260
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 740 CHEYNEY RD P.O. BOX 200
-----------------------------------------------------
City | CHEYNEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19319-1018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-399-2217
-----------------------------------------------------
Fax | 610-399-2128
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSOC PROVOST FOR STUDENT SERVICES
-----------------------------------------------------
Name | DR. VALERIE L. EPPS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-399-2217
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0005X
-----------------------------------------------------
Taxonomy Name | Ambulatory Family Planning Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------