Provider Demographics
NPI:1003820622
Name:ATLANTICARE PHYSICIAN GROUP
Entity Type:Organization
Organization Name:ATLANTICARE PHYSICIAN GROUP
Other - Org Name:ATLANTICARE URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROFESSIONAL REV CYCLE BUS PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DESHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-272-6860
Mailing Address - Street 1:2500 ENGLISH CREEK AVE BLDG 900
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5549
Mailing Address - Country:US
Mailing Address - Phone:609-407-2380
Mailing Address - Fax:
Practice Address - Street 1:110 E JIMMIE LEEDS RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9479
Practice Address - Country:US
Practice Address - Phone:609-748-2100
Practice Address - Fax:609-748-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
057854Medicare ID - Type Unspecified