NPIMap

Organization Active NPI

Atlanticare Physician Group PA

Doing business as AtlantiCare Urgent Care - Clementon

  • Non-Pharmacy Dispensing Site
  • Clementon, NJ
National Provider Identifier
1972957660
Registry record updated Apr 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
25MA08229800 Issued in NJ
Legal business name
ATLANTICARE PHYSICIAN GROUP PA
Doing business as
AtlantiCare Urgent Care - Clementon
Practice address
1310 Blackwood Clementon Rd
Clementon, NJ 08021-5610
Phone
(865) 783-1802
NPI assigned
Apr 19, 2016
Last updated
Apr 19, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 19, 2016

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

Authorized official

Name
Kenny Heine
Title
VP of Operations
Phone
(858) 964-1506

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X 25MA08229800 NJ Primary

Addresses

Primary practice location

1310 Blackwood Clementon Rd
Clementon, NJ 08021-5610

Mailing address

9276 Scranton Rd
Suite 100
San Diego, CA 92121-7701

Other names 1

  • AtlantiCare Urgent Care - Clementon Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Atlanticare Physician Group PC22 organizations share this tax ID, including this one
Part of
Medvantx Inc

Other organizations with this tax ID 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1461024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461024000000",
    "number": "1972957660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9276 SCRANTON RD",
            "address_2": "SUITE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921217701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 BLACKWOOD CLEMENTON RD",
            "city": "CLEMENTON",
            "state": "NJ",
            "postal_code": "080215610",
            "telephone_number": "865-783-1802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTICARE PHYSICIAN GROUP PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2016-04-19",
        "last_updated": "2016-04-19",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NJ",
            "license": "25MA08229800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AtlantiCare Urgent Care - Clementon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clementon, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2016; 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.