Organization
TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Active
Parent organization
TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Other names
Penn Medicine at Radnor Endoscopy Facility
Organization subpart
Yes
Provider details
NPI number
Legal business name
TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Authorized official
CHANTE L JACKSON (LEAD COORDINTOR)
(215) 662-6187
Entity
Organization
Contact information
Practice address
250 KING OF PRUSSIA RD, RADNOR, PA 19087-5220
(610) 902-1500
Mailing address
250 KING OF PRUSSIA RD, RADNOR, PA 19087-5220
(610) 902-1500
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
—
—
261QE0800X
Endoscopy Clinic/Center
Primary
1675
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1461
INDEPENDENCE BLUE CROSS
PA
01
—
707804
AETNA U S HEALTHCARE
PA
Enumeration date
01/19/2007
Last updated
04/23/2020
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