Organization
UNIVERSITY OF PENN-MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANTE L JACKSON (ENROLLMENT LEAD)
(215) 662-6187
Entity
Organization
Contact information
Practice address
3400 CIVIC CENTER BLVD, 2 EAST PAVILLION, PHILADELPHIA, PA 19104-5127
(215) 615-4949
Mailing address
3400 CIVIC CENTER BLVD, 2 EAST PAVILLION, PHILADELPHIA, PA 19104-5127
(215) 615-4949
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
PA
Other
Enumeration date
12/29/2014
Last updated
11/19/2020
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up