University Of Penn-medical Group
Internal Medicine Physician in Philadelphia, PA(View on Map)
Legal Business Name
University Of Penn-medical Group
NPI Number
1386751089
NPI Type
Organization
Enumeration Date
08/25/2006
Specialties
(Taxonomies)Contact
Information
Purpose
Mailing
Location
Address
51 N 39TH ST
51 N 39TH ST
City
Philadelphia
Philadelphia
State
PA
PA
Postal Code
19104-2640
19104-2640
Country
US
US
Telephone Number
(215) 662-8000
(215) 662-8000
Authorized Official
Name
Chante Jackson
Title or Position
ENROLLMENT LEAD
Telephone Number
(215) 662-6187
Identifiers
Identifier
0006610360
06638
5543509
273200
40063
G00048520
0053945000
0002Y20116
147249
Unknown
Unknown
Identifier State
PA
PA
NJ
PA
PA
PA
PA
PA
PA
Unknown
Unknown
Identifier Issuer
Unknown
HEALTHPARTNERS
NJ-MEDICAID
MAMSI
MERCY
AMERICHOICE
KEYSTONE
HEALTHNET
BLUE SHIELD
Unknown
Unknown
Health Information Exchange
Endpoint Type
CONNECT
Endpoint
https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service
Endpoint Description
2.16.840.1.113883.3.1068.1
Use
Other
Content Type
Unknown
Affiliation
Y
Endpoint Location
Cobius Healthcare Solutions2720 Dundee Rd # 302Northbrook, IL600622609US
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 11/19/2020
Provider Address
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