Active NPI
Fox Chase Cancer Center Medical Group Inc,
Doing business as Gastro Assoc of FCCC, MGI
- Gastroenterology Physician
- Philadelphia, PA
National Provider Identifier
1417221607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- Legal business name
- FOX CHASE CANCER CENTER MEDICAL GROUP INC,
- Doing business as
- Gastro Assoc of FCCC, MGI
- Practice address
- 333 Cottman Ave
Philadelphia, PA 19111-2434 - Phone
- (215) 214-1424
- Fax
- (215) 214-1425
- NPI assigned
- Mar 6, 2012
- Last updated
- Jun 14, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Tonya Woodard
- Title
- Credentialing/Manager
- Phone
- (215) 707-3911
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | PA | Primary |
Addresses
Primary practice location
333 Cottman Ave
Philadelphia, PA 19111-2434
Mailing address
2450 W Hunting Park Ave
Philadelphia, PA 19129-1302
Phone (215) 214-1424
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1026888280012 | Medicaid | PA |
Other names 1
- Gastro Assoc of FCCC, MGI
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330992000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1528934400000",
"number": "1417221607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2450 W HUNTING PARK AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191291302",
"telephone_number": "215-214-1424",
"fax_number": "215-214-1425"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 COTTMAN AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191112434",
"telephone_number": "215-214-1424",
"fax_number": "215-214-1425"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FOX CHASE CANCER CENTER MEDICAL GROUP INC,",
"organizational_subpart": "NO",
"enumeration_date": "2012-03-06",
"last_updated": "2018-06-14",
"status": "A",
"authorized_official_last_name": "WOODARD",
"authorized_official_first_name": "TONYA",
"authorized_official_title_or_position": "CREDENTIALING/MANAGER",
"authorized_official_telephone_number": "215-707-3911"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "PA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1026888280012",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Gastro Assoc of FCCC, MGI",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Gastro Assoc of FCCC, MGI",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Philadelphia, PA
- Fox and Ferns Mental Health, LLC
- Fox Chase Adult Day Care Inc.
- Fox Chase Anesthesiology Assoc PC
- Fox Chase Cancer Center
- Fox Chase Cancer Center Medical Group Inc (Anesthesia Assoc of FCCC, MGI)
- Fox Chase Cancer Center Medical Group, Inc (Thor Surg Assoc of FCCC, MGI)
- Fox Chase Cancer Center Medical Group, Inc (Plastic/Recon Assoc of FCCC, MGI)
- Fox Chase Cancer Center Medical Group, Inc (Psychology Assoc of FCCC, MGI)
- Fox Chase Cancer Center Medical Group, Inc (PATH Assoc of FCCC, MGI)
- Fox Chase Cancer Center Medical Group, Inc (Uro Assoc of FCCC, MGI)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.