NPIMap

Organization Active NPI

Thomas Jefferson University Hospital

  • Ambulatory Surgical Clinic/Center
  • Philadelphia, PA
National Provider Identifier
1255409405
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
200801 Issued in PA
Legal business name
THOMAS JEFFERSON UNIVERSITY HOSPITAL
Practice address
111 S 11TH St
2210 Gibbon Building
Philadelphia, PA 19107-4824
Phone
(215) 955-7106
Fax
(215) 955-8732
NPI assigned
Dec 4, 2006
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. Neil Lubarsky
Title
Senior Vice President
Phone
(215) 955-9895

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 200801 PA Primary

Addresses

Primary practice location

111 S 11TH St
2210 Gibbon Building
Philadelphia, PA 19107-4824

Mailing address

PO Box 85009895
Philadelphia, PA 19178-0001
Phone (215) 955-7106

Other identifiers 1

IdentifierTypeStateIssuer
1007571300057MedicaidPA

National Provider Directory

National Provider Directory
Tax ID family
Thomas Jefferson Univ H13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255409405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 85009895",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191780001",
            "telephone_number": "215-955-7106",
            "fax_number": "215-955-8732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "address_2": "2210 GIBBON BUILDING",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-955-7106",
            "fax_number": "215-955-8732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS JEFFERSON UNIVERSITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LUBARSKY",
        "authorized_official_first_name": "NEIL",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "215-955-9895",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "PA",
            "license": "200801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007571300057",
            "state": "PA"
        }
    ],
    "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.