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Organization
CLINICAL CARE ASSOCIATES OF THE UNIVERSITY OF PENNSYLVANIA HEALTH SYST
Active
Organization
CLINICAL CARE ASSOCIATES OF THE UNIVERSITY OF PENNSYLVANIA HEALTH SYST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANTE L JACKSON (ENROLLMENT LEAD)
(215) 662-6187
Entity
Organization
Contact information
Practice address
1930 SOUTH BROAD ST, UNIT 28, PENN URGENT CARE SOUTH PHILADELPHIA, PHILADELPHIA, PA 19145-2328
(215) 419-7500
(215) 419-7505
Mailing address
250 KING OF PRUSSIA RD FL 4, RADNOR, PA 19087-5235
(610) 902-1720
(610) 902-1789
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
PA
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
PA
207RH0003X
Hematology & Oncology Physician
—
—
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
—
PA
2084N0400X
Neurology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
PA
208600000X
Surgery Physician
—
—
208C00000X
Colon & Rectal Surgery Physician
—
—
213EP1101X
Primary Podiatric Medicine Podiatrist
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
—
PA
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Enumeration date
08/02/2017
Last updated
06/09/2021
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