NPIMap

Organization Active NPI

VA Medical Center, Philadelphia PA

  • Clinical Medical Laboratory
  • Philadelphia, PA
National Provider Identifier
1245325356
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
MD-036835L Issued in PA
Legal business name
VA MEDICAL CENTER, PHILADELPHIA PA
Practice address
3900 Woodland Avenue
Pathology & Lab. Med. (113) - Vamc Clin. Add. BLDG.
Philadelphia, PA 19104-4551
Phone
(215) 823-5182
Fax
(215) 823-4271
NPI assigned
Oct 4, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Michael J Sullivan
Title
Director
Phone
(215) 823-5857

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X MD-036835L PA Primary

Addresses

Primary practice location

3900 Woodland Avenue
Pathology & Lab. Med. (113) - Vamc Clin. Add. BLDG.
Philadelphia, PA 19104-4551

Mailing address

715 N. Ithan Avenue
Rosemont, PA 19010-1729
Phone (215) 823-5182

National Provider Directory

National Provider Directory
Tax ID family
Philadelphia Vamc15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Locations

3900 Woodland Ave
#113
Philadelphia, PA 19104
Phone (215) 823-5182

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245325356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 N. ITHAN AVENUE",
            "city": "ROSEMONT",
            "state": "PA",
            "postal_code": "190101729",
            "telephone_number": "215-823-5182",
            "fax_number": "215-823-4271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 WOODLAND AVENUE",
            "address_2": "PATHOLOGY & LAB. MED. (113) - VAMC CLIN. ADD. BLDG.",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044551",
            "telephone_number": "215-823-5182",
            "fax_number": "215-823-4271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VA MEDICAL CENTER, PHILADELPHIA PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "215-823-5857",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PA",
            "license": "MD-036835L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.