MEDICARE: JEFFERSON UNIVERSITY HOSPITAL

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
1	261Q00000X	Clinic/Center	MT188493	PA

General Provider Information

NPI Number	:	1861725608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERSON UNIVERSITY HOSPITAL

Provider Business Mailing Address
First Line	:	211 S 9TH ST
Second Line	:	SUITE 600,WALNUT TOWERS
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-6810
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 WALNUT ST
Second Line	:	1015 WALNUT STREET
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5005
Country	:	US
Telephone Number	:	215-955-4516
Fax Number	:

Authorized Official
Title or Position	:	RHEUMATOLOGY CHIEF & DIRECTOR
Name	:	DR. OSCAR IRIGOYEN
Credential	:	M.D
Telephone Number	:	215-955-1410

Provider Enumeration Date	:	09/11/2009
Last Update Date	:	09/11/2009

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Directions to “JEFFERSON UNIVERSITY HOSPITAL ” Practice Location

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