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Atlanticare Physician Group PA

Organization Active NPI Non-Pharmacy Dispensing Site · Somers Point, NJ

NPI 1073909792 · NPPES record last updated Oct 14, 2016

Key facts

NPI
1073909792
Entity type
Organization (NPI type 2)
Primary specialty
Non-Pharmacy Dispensing Site 332900000X
License
25MB08578500 (NJ)
Legal business name
ATLANTICARE PHYSICIAN GROUP PA
Practice address
443 Shore Rd
Suite 103
Somers Point, NJ 08244-2642
Phone
(609) 569-7077
NPI assigned
Apr 9, 2015
Organization subpart
Yes
Parent organization (as reported)
MEDVANTX, INC.

Authorized official

Name
Scott Peterson
Title
Cfo
Phone
(858) 625-2990

Corporate family (same tax ID) 21

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Atlanitcare Physician Group (22 organizations share this tax ID)
Part of
Tri - State Medical Group Inc

Locations

443 Shore Rd
Ste 103
Somers Point, NJ 08244
Phone (609) 569-7077

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X 25MB08578500 NJ Yes

Addresses

Primary practice location

443 Shore Rd
Suite 103
Somers Point, NJ 08244-2642

Mailing address

9276 Scranton Rd
Suite 100
San Diego, CA 92121-7701

Other names

  • AtlantiCare Urgent Care-Somers Point Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 14, 2016.

{
    "created_epoch": "1428537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476403200000",
    "number": "1073909792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9276 SCRANTON RD",
            "address_2": "SUITE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921217701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "443 SHORE RD",
            "address_2": "SUITE 103",
            "city": "SOMERS POINT",
            "state": "NJ",
            "postal_code": "082442642",
            "telephone_number": "609-569-7077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTICARE PHYSICIAN GROUP PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2015-04-09",
        "last_updated": "2016-10-14",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NJ",
            "license": "25MB08578500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AtlantiCare Urgent Care-Somers Point",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Somers Point, NJ

All providers in Somers Point, NJ · Non-Pharmacy Dispensing Site in New Jersey

Sources for this page

Verify at the official NPI Registry.