NPIMap

Organization Active NPI

Thomas Jefferson University

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Philadelphia, PA
National Provider Identifier
1972622306
Registry record updated Oct 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
800000127 Issued in PA
Legal business name
THOMAS JEFFERSON UNIVERSITY
Practice address
1239 Spring Garden St
Philadelphia, PA 19123-3206
Phone
(215) 763-1020
Fax
(215) 763-4640
NPI assigned
Mar 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2017

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

Authorized official

Name
Michelle Calvano, BA
Title
Business Manager
Phone
(215) 955-1952

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 800000127 PA Primary

Addresses

Primary practice location

1239 Spring Garden St
Philadelphia, PA 19123-3206

Mailing address

1233 Locust St Ste 401
Philadelphia, PA 19107-5459
Phone (215) 955-1952

Other identifiers 1

IdentifierTypeStateIssuer
1007571300097MedicaidPA

National Provider Directory

National Provider Directory
Tax ID family
Jefferson Community Onc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

1233 Locust St
Ste 401
Philadelphia, PA 19107
Phone (215) 955-8577

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508198400000",
    "number": "1972622306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1233 LOCUST ST STE 401",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075459",
            "telephone_number": "215-955-1952",
            "fax_number": "215-568-6414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1239 SPRING GARDEN ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191233206",
            "telephone_number": "215-763-1020",
            "fax_number": "215-763-4640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS JEFFERSON UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2017-10-17",
        "status": "A",
        "authorized_official_last_name": "CALVANO",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "215-955-1952",
        "authorized_official_credential": "BA"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "PA",
            "license": "800000127",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007571300097",
            "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 Oct 17, 2017; 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.