Organization
PRIME HEALTHCARE SERVICES-ROXBOROUGH PROVIDERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY C. RICHARDS (AUTHORIZED REPRESENTATIVE)
(215) 509-6826
Entity
Organization
Contact information
Practice address
5800 RIDGE AVE, PHILADELPHIA, PA 19128-1737
(215) 509-6826
(215) 487-4274
Mailing address
5800 RIDGE AVE, PHILADELPHIA, PA 19128-1737
(215) 509-6826
(215) 487-4274
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
PA
363A00000X
Physician Assistant
—
PA
363L00000X
Nurse Practitioner
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102765014
—
PA
Enumeration date
07/17/2012
Last updated
04/10/2013
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