Organization
US VASCULAR ACCESS CENTER OF PHILADELPHIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. EDITH MONTGOMERY (SR.MGR. REGULATORY/REIMBURSEMENT)
(407) 661-5766
Entity
Organization
Contact information
Practice address
4220 MARKET ST, SECOND FLOOR, PHILADELPHIA, PA 19104-3007
(215) 386-4959
Mailing address
4220 MARKET ST, SECOND FLOOR, PHILADELPHIA, PA 19104-3007
(215) 386-4959
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
20461501
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20461501
STATE LICENSE
PA
Enumeration date
12/27/2007
Last updated
12/27/2007
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