Provider Demographics
NPI:1043379506
Name:ST.CHRIS CARE AT NORTHEAST PEDIATRICS, LLC
Entity Type:Organization
Organization Name:ST.CHRIS CARE AT NORTHEAST PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL CFO, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-265-5009
Mailing Address - Street 1:PO BOX 822502
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-1029
Mailing Address - Country:US
Mailing Address - Phone:214-969-4917
Mailing Address - Fax:215-969-5875
Practice Address - Street 1:9501 ROOSEVELT BLVD STE 410
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1029
Practice Address - Country:US
Practice Address - Phone:214-969-4917
Practice Address - Fax:215-969-5875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty