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
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
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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