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NPI Code Detail

MEDICARE: SPUC, LLC

MEDICARE: SPUC, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QU0200XUrgent Care Clinic/CenterMD435698PA

General Provider Information

NPI Number : 1518387562
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPUC, LLC
Provider Business Mailing Address
First Line : 1444 W PASSYUNK AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19145-2312
Country : US
Telephone Number : 215-964-9250
Fax Number : 215-964-9445
Provider Business Practice Location Address
First Line : 1444 W PASSYUNK AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19145-2312
Country : US
Telephone Number : 215-964-9250
Fax Number : 215-964-9445
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : MADHAVI CHERUKURI
Credential : MD
Telephone Number : 610-518-1060
Provider Enumeration Date : 04/17/2014
Last Update Date : 06/01/2016

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