Olive Branch Medical Center

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

OS004959L Issued in PA

Legal business name

OLIVE BRANCH MEDICAL CENTER

Practice address

2 Bala PLZ Ste 50
Bala Cynwyd, PA 19004-1501

Phone

(215) 200-3913

NPI assigned

Nov 12, 2014

Last updated

Sep 28, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Loretta F Brown, D.O.

Title

Owner

Phone

(215) 200-3913

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1415750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443398400000",
    "number": "1932505385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5427 WAYNE AVE APT G22",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191443455",
            "telephone_number": "215-200-3913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 BALA PLZ STE 50",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190041501",
            "telephone_number": "215-200-3913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVE BRANCH MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-12",
        "last_updated": "2015-09-28",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "LORETTA",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-200-3913",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS004959L",
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "PA",
            "license": "OS004959L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Bala Cynwyd, PA
• Providers in Bala Cynwyd, PA by specialty
• Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2015; 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.