=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831143890
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INSPIRA MEDICAL CENTERS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2006
-----------------------------------------------------
Last Update Date | 11/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 IRVING AVENUE
-----------------------------------------------------
City | BRIDGETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08302-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-575-4500
-----------------------------------------------------
Fax | 856-451-5269
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 IRVING AVENUE
-----------------------------------------------------
City | BRIDGETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08302-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-575-4500
-----------------------------------------------------
Fax | 856-451-5269
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF REVENUE CYCLE
-----------------------------------------------------
Name | MR. JAMES THOMAS O'CONNELL
-----------------------------------------------------
Credential | CPA
-----------------------------------------------------
Telephone | 856-575-4777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273R00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital Unit
-----------------------------------------------------
License Number | 10603
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------