Provider Demographics
NPI:1053630368
Name:TPS IV OF PA., LLC
Entity Type:Organization
Organization Name:TPS IV OF PA., LLC
Other - Org Name:UNIVERSITY ORTHOPAEDIC INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP REGIONAL OPERATIONS, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-6193
Mailing Address - Street 1:PO BOX 827965
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-7965
Mailing Address - Country:US
Mailing Address - Phone:856-396-0940
Mailing Address - Fax:856-396-0127
Practice Address - Street 1:1300 LINCOLN DR. WEST STE 301
Practice Address - Street 2:4 GREENTREE CENTER
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3408
Practice Address - Country:US
Practice Address - Phone:856-396-0940
Practice Address - Fax:856-396-0127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty