Organization
DEDICATED PENNSYLVANIA HOLDING, LLC
Active
Parent organization
DEDICATED PENNSYLVANIA HOLDING, LLC
Other names
Dedicated Pennsylvania North Philadelphia
Organization subpart
Yes
Provider details
NPI number
Legal business name
DEDICATED PENNSYLVANIA HOLDING, LLC
Authorized official
MR. RAYMOND JIMENEZ (DIR OF CLIENT SVCS)
(786) 870-4039
Entity
Organization
Contact information
Practice address
2101 W LEHIGH AVE STE A, PHILADELPHIA, PA 19132-2664
(305) 628-6117
(786) 870-4039
Mailing address
1395 N.W. 167TH STREET, PAYER ENROLLMENT DEPARTMENT, MIAMI GARDENS, FL 33169
(786) 870-4039
(786) 870-4039
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
332900000X
Non-Pharmacy Dispensing Site
—
—
Other
Enumeration date
03/13/2018
Last updated
03/13/2018
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